Dental procedures during pandemic are no riskier than a drink of water, study finds

A new study's findings dispel the misconception that patients and providers are at high risk of catching COVID-19 at the dentist's office.

SARS-CoV-2 spreads mainly through respiratory droplets, and dental procedures are known to produce an abundance of aerosols -- leading to fears that flying saliva during a cleaning or a restorative procedure could make the dentist's chair a high-transmission location.

Ohio State University researchers set out to determine whether saliva is the main source of the spray, collecting samples from personnel, equipment and other surfaces reached by aerosols during a range of dental procedures.

By analyzing the genetic makeup of the organisms detected in those samples, the researchers determined that watery solution from irrigation tools, not saliva, was the main source of any bacteria or viruses present in the spatter and spurts from patients' mouths.

Even when low levels of the SARS-CoV-2 virus were detected in the saliva of asymptomatic patients, the aerosols generated during their procedures showed no signs of the coronavirus. In essence, from a microbial standpoint, the contents of the spray mirrored what was in the office environment.

"Getting your teeth cleaned does not increase your risk for COVID-19 infection any more than drinking a glass of water from the dentist's office does," said lead author Purnima Kumar, professor of periodontology at Ohio State.

"These findings should help us open up our practices, make ourselves feel safe about our environment and, for patients, get their oral and dental problems treated -- there is so much evidence emerging that if you have poor oral health, you are more susceptible to COVID," Kumar said.

The study was published Wednesday, May 12, in the Journal of Dental Research.

Previous research has shown that dental-procedure aerosols tend to land on providers' faces and the patient's chest, and can travel as far as 11 feet. But the studies, catching the spray in petri dishes placed on people, equipment and around the room, found only that bacteria existed -- they rarely identified the organisms and never determined where they came from. Saliva has been the presumptive source for a long time.

When saliva was considered potentially deadly at the start of the pandemic, Kumar decided a long-term answer was needed to settle the question of whether saliva is the source of dental aerosols.

For the study, the team enrolled 28 patients receiving dental implants and restorations using high-speed drills or ultrasonic scaling procedures in Ohio State's College of Dentistry between May 4 and July 10, 2020. Researchers collected samples of saliva and irrigant (the water-based cleaning solutions used to flush out the mouth) before each procedure and, 30 minutes after the procedure, aerosol remnants -- condensate -- from providers' face shields, the patient's bib and an area 6 feet away from the chair.

Kumar and colleagues then put genome sequencing technology to use that wasn't available in the petri-dish days. This allowed them to first characterize the microbial mix in pre-procedure saliva and irrigants, which they could then compare to organisms in the aerosol samples collected later.

With the analytical method they used, the researchers did not need to characterize the microbes -- they instead looked for variations in sequences that provided enough information to identify the family of bacteria or viruses to which they belonged.

"Some species that live in your mouth can closely resemble those in water and the environment. Using this method, we don't even have to know the names of these organisms -- you can tell whether they are exactly genetically identical or genetically different," Kumar said. "If you use this granular approach to see these very nuanced differences in the genetic code, you can very accurately identify where they're coming from."

No matter the procedure or where the condensate had landed, microbes from irrigants contributed to about 78% of the organisms in aerosols while saliva, if present, accounted for 0.1% to 1.2% of the microbes distributed around the room.

Salivary bacteria were detected in condensate from only eight cases and of those, five patients had not used a pre-procedural mouth rinse. The SARS-CoV-2 virus was identified in the saliva of 19 patients, but was undetectable in aerosols in any of the cases.

The findings are reassuring, but also make sense, Kumar said: Irrigant dilutes saliva -- a "thick, viscous" substance -- by an estimated 20- to 200-fold, and the research is validated by a 2020 study that reported a less than 1% COVID-19 positivity rate among dentists.

Kumar noted that dentistry has long been at the forefront of infection-control practices in health care. During the pandemic, new protocols have included strengthened ventilation systems, extra aerosol suction equipment, N95 masks and face shields on top of goggles, and extended downtime between patients. She is hopeful this study's findings will make practitioners and patients feel at ease about being in the dentist's office -- with continued stringent protection in place.

"Dental surgeons and hygienists are always at the forefront of the war against bacteria in the mouth, and they of course did not feel safe because they are front-line workers surrounded by aerosol," said Kumar, who has a periodontology practice of her own and was one of the procedure operators in the study.

"Hopefully this will set their mind at rest because when you do procedures, it is the water from the ultrasonic equipment that's causing bacteria to be there. It's not saliva. So the risk of spreading infection is not high," she said. "However, we should not lose sight of the fact that this virus spreads through aerosol, and speaking, coughing or sneezing in the dental office can still carry a high risk of disease transmission."

Co-authors of the study include Archana Meethil, Shwetha Saraswat and Shareef Dabdoub of Ohio State and Prem Prashant Chaudhary of the National Institute of Allergy and Infectious Diseases.

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Good dental health may help prevent heart infection from mouth bacteria

Maintenance of good oral health is more important than use of antibiotics in dental procedures for some heart patients to prevent a heart infection caused by bacteria around the teeth, according to a new American Heart Association (AHA) scientific statement published today in the association's flagship journal, Circulation.

Infective endocarditis (IE), also called bacterial endocarditis, is a heart infection caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel. It is uncommon, but people with heart valve disease or previous valve surgery, congenital heart disease or recurrent infective endocarditis have a greater risk of complications if they develop IE. Intravenous drug use also increases risk for IE. Viridans group streptococcal infective endocarditis (VGS IE) is caused by bacteria that collect in plaque on the tooth surface and cause inflammation and swelling of the gums. There's been concern that certain dental procedures may increase the risk of developing VGS IE in vulnerable patients.

The new guidance affirms previous recommendations that only four categories of heart patients should be prescribed antibiotics prior to certain dental procedures to prevent VGS IE due to their higher risk for complications from the infection:

those with prosthetic heart valves or prosthetic material used for valve repair;

those who have had a previous case of infective endocarditis;

adults and children with congenital heart disease; or

people who have undergone a heart transplant.

"Scientific data since the 2007 AHA guidelines support the view that limited use of preventive antibiotics for dental procedures hasn't increased cases of endocarditis and is an important step at combating antibiotic overuse in the population," said Walter R. Wilson, M.D., chair of the statement writing group and a consultant for the Division of Infectious Diseases, Department of Internal Medicine at Mayo Clinic in Rochester, Minn.

It has been over a decade since recommendations for preventing infective endocarditis were updated amid concerns of antibiotic resistance due to overprescribing. The American Heart Association's 2007 guidelines, which presented the biggest shift in recommendations from the Association on the prevention of infective endocarditis in more than 50 years, more tightly defined which patients should receive preventive antibiotics before certain dental procedures to the four high-risk categories. This change resulted in about 90% fewer patients requiring antibiotics.

The scientific statement writing group reviewed data on VGS IE since the 2007 guidelines to determine if the guidelines had been accepted and followed, whether cases of and mortality due to VGS IE have increased or decreased, and if the guidance might need to be adjusted.

The writing committee reports their extensive review of related research found:

There was good general awareness of the changes in the 2007 guidelines, however, adherence to the guidelines was variable. There was about a 20% overall reduction in prescribing preventive antibiotics among high-risk patients, a 64% decrease among moderate-risk patients, and a 52% decrease in those patients at low- or unknown-risk.

In a survey of 5,500 dentists in the U.S., 70% reported prescribing preventive antibiotics to patients even though the guidelines no longer recommend it, and this was most often for patients with mitral valve prolapse and five other cardiac conditions. The dentists reported that about 60% of the time the antibiotic regimen was recommended by the patient's physician, and 1/3 of the time was according to patient preference.

Since the stricter 2007 antibiotic guidelines, there is no convincing evidence of an increase in cases of VGS IE or increased mortality due to VGS IE.

The writing group supports the 2007 recommendation that only the highest risk groups of patients receive antibiotics prior to certain dental procedures to help prevent VGS IE.

In the presence of poor oral hygiene and gingival disease, VGS IE is far more likely to develop from bacteria attributable to routine daily activities such as toothbrushing than from a dental procedure.

Maintenance of good oral hygiene and regular access to dental care are considered as important in preventing VGS IE as taking antibiotics before certain dental procedures.

It is important to connect patients with services to facilitate access to dental care and assistance with insurance for dental coverage, especially in those patients at high risk for VGS IE.

It is still appropriate to follow the recommendation to use preventive antibiotics with high-risk patients undergoing dental procedures that involve manipulation of the gum tissue or infected areas of the teeth, or perforation of the membrane lining the mouth.

The scientific statement was prepared by the volunteer writing committee on behalf of the American Heart Association's Young Hearts Rheumatic Fever, Endocarditis and Kawasaki Disease Committee; the Council on Lifelong Congenital Heart Disease and Heart Health in the Young; the Council on Cardiovascular and Stroke Nursing; and the Council on Quality of Care and Outcomes Research.

How Teeth Sense the Cold

For people with tooth decay, drinking a cold beverage can be agony.

"It's a unique kind of pain," says David Clapham, vice president and chief scientific officer of the Howard Hughes Medical Institute (HHMI). "It's just excruciating."

Now, he and an international team of scientists have figured out how teeth sense the cold and pinpointed the molecular and cellular players involved. In both mice and humans, tooth cells called odontoblasts contain cold-sensitive proteins that detect temperature drops, the team reports March 26, 2021, in the journal Science Advances. Signals from these cells can ultimately trigger a jolt of pain to the brain.

The work offers an explanation for how one age-old home remedy eases toothaches. The main ingredient in clove oil, which has been used for centuries in dentistry, contains a chemical that blocks the "cold sensor"protein, says electrophysiologist Katharina Zimmermann, who led the work at Friedrich-Alexander University Erlangen-Nürnberg in Germany.

Developing drugs that target this sensor even more specifically could potentially eliminate tooth sensitivity to cold, Zimmermann says. "Once you have a molecule to target, there is a possibility of treatment."

Mystery channel

Teeth decay when films of bacteria and acid eat away at the enamel, the hard, whitish covering of teeth. As enamel erodes, pits called cavities form. Roughly 2.4 billion people -- about a third of the world's population -- have untreated cavities in permanent teeth, which can cause intense pain, including extreme cold sensitivity.

No one really knew how teeth sensed the cold, though scientists had proposed one main theory. Tiny canals inside the teeth contain fluid that moves when the temperature changes. Somehow, nerves can sense the direction of this movement, which signals whether a tooth is hot or cold, some researchers have suggested.

"We can't rule this theory out," but there wasn't any direct evidence for it, says Clapham a neurobiologist at HHMI's Janelia Research Campus. Fluid movement in teeth -- and tooth biology in general -- is difficult to study. Scientists have to cut through the enamel -- the hardest substance in the human body -- and another tough layer called dentin, all without pulverizing the tooth's soft pulp and the blood vessels and nerves within it. Sometimes, the whole tooth "will just fall to pieces," Zimmermann says.

Zimmerman, Clapham, and their colleagues didn't set out to study teeth. Their work focused primarily on ion channels, pores in cells' membranes that act like molecular gates. After detecting a signal -- a chemical message or temperature change, for example -- the channels either clamp shut or open wide and let ions flood into the cell. This creates an electrical pulse that zips from cell to cell. It's a rapid way to send information, and crucial in the brain, heart, and other tissues.

About fifteen years ago, when Zimmermann was a postdoc in Clapham's lab, the team discovered that an ion channel called TRPC5 was highly sensitive to the cold. But the team didn't know where in the body TRPC5's cold-sensing ability came into play. It wasn't the skin, they found. Mice that lacked the ion channel could still sense the cold, the team reported in 2011 in the journal Proceedings of the National Academy of Sciences.

After that, "we hit a dead end," Zimmermann says. The team was sitting at lunch one day discussing the problem when the idea finally hit. "David said, 'Well, what other tissues in the body sense the cold?' Zimmermann recalls. The answer was teeth.

The whole tooth

TRPC5 does reside in teeth -- and more so in teeth with cavities, study coauthor Jochen Lennerz, a pathologist from Massachusetts General Hospital, discovered after examining specimens from human adults.

A novel experimental set up in mice convinced the researchers that TRPC5 indeed functions as a cold sensor. Instead of cracking a tooth open and solely examining its cells in a dish, Zimmermann's team looked at the whole system: jawbone, teeth, and tooth nerves. The team recorded neural activity as an ice-cold solution touched the tooth. In normal mice, this frigid dip sparked nerve activity, indicating the tooth was sensing the cold. Not so in mice lacking TRPC5 or in teeth treated with a chemical that blocked the ion channel. That was a key clue that the ion channel could detect cold, Zimmermann says. One other ion channel the team studied, TRPA1, also seemed to play a role.

The team traced TRPC5's location to a specific cell type, the odontoblast, that resides between the pulp and the dentin. When someone with a a dentin-exposed tooth bites down on a popsicle, for example, those TRPC5-packed cells pick up on the cold sensation and an "ow!" signal speeds to the brain.

That sharp sensation hasn't been as extensively studied as other areas of science, Clapham says. Tooth pain may not be considered a trendy subject, he says, "but it is important and it affects a lot of people."

Zimmermann points out that the team's journey towards this discovery spanned more than a decade. Figuring out the function of particular molecules and cells is difficult, she says. "And good research can take a long time."

Her Song and Tim Tebow Foundation Donations

Her Song is an organization who’s mission is to interrupt the cycle of human trafficking and leading the exploited to freedom through Survivor Care, Victim Outreach, and Education. The Tim Tebow Foundation is committed to engaging in the global fight against human trafficking and supporting the rescue and restoration of those who have been trafficked or who are at risk of becoming victims. They are accomplishing this goal in three primary ways - proactively, reactively, and relationally.

Our office works with the Her Song organization in providing preventative dental care and completing restorative work, giving girls a newfound confidence and joy with each treatment.

Her Song is a group of Christian people who are called, equipped, and sent according to the Gospel. The Tim Tebow Foundation also works very closely with the Her Song organization and the Tim Tebow Foundation has recently started a new donation goal. There are two ways you can donate you can either donate on the Her song donation page (Link Below) or through the Tim Tebow foundation donation page (Link Below). Her Song also has an Amazon wish list if you would like to help that way.

https://www.hersong.org/make-a-donation

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Our Office Will be Closed For Continuing Education

Our office will be closed from June 24, 2021 to June 28th, 2021 (06/24/2021 - 06/28/2021) for the Florida Dental Association Convention and continuing education. We will reopen on June 29th, 2021 and resuming our normal business hours. If you are experiencing a true Dental Emergency, please contact us at (904) 762-5616

Uneven Jaw

Overview

An uneven jaw can contribute to issues with eating, sleeping, talking, and breathing. There are a range of causes of an uneven jaw. Some cases can be treated and improved with physical therapy. Others may require corrective surgery.

Read on to learn more about uneven jaw causes, treatments, and more.

Symptoms of an uneven jaw

Symptoms of an uneven jaw are often similar to those of other conditions. They may include:

• pain in the temple

• pain in the jaw joint area

• clicking jaw

• tight jaw

• pain in shoulder or back

• popping in ear
  

Causes and treatments of an uneven jaw

Jaw function requires tendons, bones, and muscles to work together. An imbalance in any of these structures can lead to the entire jaw becoming uneven.

There are several reasons why your jaw may be uneven, including:

Trauma or broken jaw

Trauma can occur during an accident, fall, assault, or a sports-related injury. Trauma can result in your jaw being broken, fractured, or dislocated.

A slight fracture will usually heal on its own. A major break in the jaw could require surgery to help the jaw heal properly. A dislocated jaw may need to be surgically stabilized.

TMJ disorders

Temporomandibular joint disorders (TMJ) are very common. Trauma or arthritis may be the cause of TMJ. Sometimes the symptoms can occur without an obvious cause, though.

You can treat TMJ by doing the following:

Apply ice to your jaw to reduce pain and inflammation.

Take an over-the-counter pain reliever, such as acetaminophen (Tylenol) or ibuprofen (Advil).

Avoid strenuous jaw movements.

Wear an orthopedic dental appliance to raise your bite and reposition the jaw.

Practice TMJ exercises to reduce pain and improve your jaw’s movement.

Manage and reduce stress to help relax your jaw.

Birth defects

You may have been born with a jaw condition. For example, you may have a naturally crooked jaw. This is also referred to as a “faulty jaw.” A faulty jaw may be corrected with surgery or can be managed with supportive care and lifestyle changes.

Teeth alignment

An uneven jaw may be due to teeth misalignment. Your teeth may not be allowing your jaw to settle in its correct position. Braces or retainers can help correct this. It may take a period of 6 to 18 months for results to show. In severe cases, it may take longer.

Surgery for uneven jaws

Correcting your jaw position sometimes requires surgery. The type of surgery chosen will depend on the underlying cause of your uneven jaw. Your doctor may choose:

Maxillary osteotomy. This is a surgery performed on the upper jaw to correct open bites or cross bites. The upper jaw and teeth are moved forward so they align with the lower jaw and teeth.

Mandibular osteotomy. This surgery corrects issues such as overbite and protruding lower jaw. Your surgeon cuts in the back of your mouth to move the lower jaw forward or backward.

Genioplasty. Genioplasty will fix a small or crooked chin. The jaw and chin are restructured by cutting the chin bone in the front of the jaw.

Jaw wiring. Jaw wiring is used to position the jaw in a certain place or provide support in the case of a fracture or break.

Takeaway

Braces or dental appliances can often treat an uneven jaw. More serious cases often need surgery.

If your jaw is causing you extreme pain, whether chronic or after an injury, see your doctor. They can assess the underlying cause of the pain and work with you to find relief.

Tobacco Use and Cessation

All of the major forms of tobacco used in the U.S. have oral health consequences. Cigarette smoking can lead to a variety of adverse oral effects, including gingival recession, impaired healing following periodontal therapy, oral cancer, mucosal lesions (e.g., oral leukoplakia, nicotine stomatitis), periodontal disease, and tooth staining. Use of smokeless tobacco is associated with increased risks of oral cancer and oral mucosal lesions (e.g., oral leukoplakia).Smokeless tobacco use also causes oral conditions such as gingival keratosis, tooth discoloration, halitosis, enamel erosion, gingival recession, alveolar bone damage, periodontal disease, coronal or root-surface dental caries due to sugars added to the product, and tooth loss.

In addition to its systemic effects, described previously, nicotine, especially that contained in nicotine replacement therapies, can have various local oral effects, including local burning sensation, throat irritation, dry lips, and mouth ulcers (depending on the formulation/method of administration); however, the local effects of nicotine replacement therapy are generally mild and self-limited Nicotine itself is not considered a direct carcinogen, but may act as a tumor promoter. A 2019 systematic review of the literature examined the specific effect of nicotine on gingival, periodontal ligament, and oral epithelial cells in in vitro models. The review found that nicotine found at levels in tobacco smoke, nicotine replacement therapy, and e-cigarettes was unlikely to be cytotoxic to oral tissues, while saliva levels with smokeless tobacco use may be potentially cytotoxic; however, data were limited and, in some cases, contradictory.

Because of the oral health implications of tobacco use, dental practices may provide a uniquely effective setting for tobacco use recognition, prevention, and cessation. Health-care professionals, including dental professionals, can help smokers quit by consistently identifying patients who smoke, advising them to quit, and offering them information about cessation treatment.

Does Oral Health Affect Pregnancy?

Oral health during pregnancy can greatly impact the mother and the fetus. While the physiological changes during pregnancy can certainly cause oral health issues, pre-existing oral health conditions can have an effect on the well-being of the mother and her unborn child.1

Dental practitioners can help their patients by educating them about the potential impact of pre-existing dental conditions, as well as diagnose and treat dental conditions that can develop with or during pregnancy.

Pre-Existing Disease

Several pre-existing conditions can negatively impact pregnancy. When examining oral health, studies support that pregnant women with pre-existing periodontal disease are at higher risk for compromised pregnancy outcomes including preterm birth, delivery of low-birth-weight babies, and development of pre-eclampsia.

In fact, women with periodontitis have double the risk of pre-term birth. Complications of pre-term birth may include developmental delays, growth reduction, and hearing impairment. But why does periodontitis cause this to happen?

The gram-negative bacteria in the gingival biofilm leads to inflammatory markers in the bloodstream. These inflammatory markers cause an immune inflammatory response in the fetal-placental unit as well as suppression of local growth factors. This response can generate uterine contractions that may result in pre-term labor and/or babies with low birth weight.

Oral Health Issues During Pregnancy

During pregnancy, the placenta produces higher levels of estrogen and progesterone. These hormonal changes may lead to increased gingivitis, gingival sensitivity to irritants, and pyogenic granulomas. This is partially due to progesterone increasing the vascular permeability.

Pregnant and/or postpartum women also may neglect their own oral care to focus on the health and well-being of their baby. This leads to toxic plaque remaining on the teeth and gums long term. Not surprisingly, approximately 60% to 75% of pregnant women have gingivitis.

In addition, the vomiting that may occur during pregnancy causes an acidic environment in the oral cavity. The acidity may lead to erosion and decay of the tooth structure.

Lastly, many women are hesitant to visit the dentist during pregnancy. This may be because there is a lack of perceived need, or they may mistakenly believe it is unsafe to visit the dentist during pregnancy.

However, research supports that professional dental care during pregnancy is integral to improving oral health. Additionally, when appropriate pregnancy guidelines are followed, dental care is safe during pregnancy. If possible, a full oral examination is recommended prior to pregnancy to achieve optimum oral health and encourage proper oral care habits at home.

Patient Communication

Dental professionals must effectively communicate the risks of pre-existing disease, such as periodontitis, to their patients who are pregnant or wish to become pregnant. Recommended conversation starters may include:

The bacteria in your mouth impacts the rest of your body and can actually lead to pre-term labor. Let’s work together to treat your periodontal disease so you can have a healthier pregnancy and baby.

I know you are planning to have children soon. Did you know that the bacteria that causes your periodontal disease can negatively impact your pregnancy? With proper treatment and home care, we can work together to manage your periodontal disease

For pregnancy gingivitis, dental professionals may say something like:

During pregnancy, your hormones may cause your gums to be more susceptible to swelling and irritation. It’s really important that you keep plaque under control. Try by brushing with an oscillating-rotating toothbrush such as the Oral-B iO and an antimicrobial paste like Crest Gum Detoxify.

The patient and dental professional must work together to stop this cycle before it begins with diligent daily oral hygiene: brushing and interdental cleaning, getting regular oral health checkups, and properly treating periodontal disease early. Oral hygiene in pregnant women can be improved by amplifying their oral care routine at home with the proper oral care products.

The primary factor for gingivitis in pregnant women, toxic plaque, can likely be ameliorated by improved hygiene including the use of antimicrobial pastes such as Crest Gum Detoxify, antimicrobial rinse like Crest Pro-Health Multi-Protection Clean Mint, and optimal mechanical plaque control via an electric rechargeable toothbrush with a round head, like the Oral-B iO.

Moreover, pastes that include stannous fluoride such as Crest Gum Detoxify can prevent the erosion that may be caused by the acidic oral environment during pregnancy. Helping your patients to take good care of their mouth, teeth, and gums during pregnancy can help them to have a healthy pregnancy and a healthy baby.

Research establishes antibiotic potential for cannabis molecule

Synthetic cannabidiol, better known as CBD, has been shown for the first time to kill the bacteria responsible for gonorrhoea, meningitis and legionnaires disease.

The research collaboration between The University of Queensland and Botanix Pharmaceuticals Limited could lead to the first new class of antibiotics for resistant bacteria in 60 years.

The UQ Institute for Molecular Bioscience's Associate Professor Mark Blaskovich said CBD -- the main nonpsychoactive component of cannabis -- can penetrate and kill a wide range of bacteria including Neisseria gonorrhoeae, which causes gonorrhoea.

"This is the first time CBD has been shown to kill some types of Gram-negative bacteria. These bacteria have an extra outer membrane, an additional line of defence that makes it harder for antibiotics to penetrate," Dr Blaskovich said. In Australia, gonorrhoea is the second most common sexually-transmitted infection and there is no longer a single reliable antibiotic to treat it because the bacteria is particularly good at developing resistance.

The study also showed that CBD was widely effective against a much larger number of Gram-positive bacteria than previously known, including antibiotic-resistant pathogens such as MRSA (methicillin-resistant Staphylococcus aureus) or 'golden staph'.

Dr Blaskovich said cannabidiol was particularly good at breaking down biofilms -- the slimy build-up of bacteria, such as dental plaque on the surface of teeth -- which help bacteria such as MRSA survive antibiotic treatments.

Dr Blaskovich's team at the Centre for Superbug Solutions mimicked a two-week patient treatment in laboratory models to see how fast the bacteria mutated to try to outwit CBD's killing power.

"Cannabidiol showed a low tendency to cause resistance in bacteria even when we sped up potential development by increasing concentrations of the antibiotic during 'treatment'."

"We think that cannabidiol kills bacteria by bursting their outer cell membranes, but we don't know yet exactly how it does that, and need to do further research.

The research team also discovered that chemical analogs -- created by slightly changing CBD's molecular structure -- were also active against the bacteria.

"This is particularly exciting because there have been no new molecular classes of antibiotics for Gram-negative infections discovered and approved since the 1960s, and we can now consider designing new analogs of CBD within improved properties."

Vince Ippolito, the President and Executive Chairman of Botanix, said the research showed vast potential for the development of effective treatments to fight the growing global threat of antibiotic resistance. "Congratulations to Dr Blaskovich and his team for producing this significant body of research -- the published data clearly establishes the potential of synthetic cannabinoids as antimicrobials," Mr Ippolito said.

"Our Company is now primed to commercialise viable antimicrobial treatments which we hope will reach more patients in the near future. This is a major breakthrough that the world needs now."

Dr Blaskovich said collaborating with Botanix has sped up the research, with Botanix contributing formulation expertise that has led to the discovery that how cannabidiol is delivered makes a huge difference in its effectiveness at killing bacteria.

The collaboration has enabled Botanix to progress a topical CBD formulation into clinical trials for decolonisation of MRSA before surgery.

"Those Phase 2a clinical results are expected early this year and we hope that this will pave the way forward for treatments for gonorrhoea, meningitis and legionnaires disease.

"Now we have established that cannabidiol is effective against these Gram-negative bacteria, we are looking at its mode of action, improving its activity and finding other similar molecules to open up the way for a new class of antibiotics."