One of the four main biomedical ethical values is autonomy, or the respect for the patient's right to self-determination. Patients should be offered options and allowed to make voluntary choices concerning medical procedures that may have life-changing consequences. One way to increase autonomy in healthcare is to increase the number of options/procedures available to a patient to solve their issues. In the dental field, the main problem plaguing patients is tooth decay or caries. Dental caries are caused by a combination of factors that include frequent consumption of sugary foods/drinks, poor dental hygiene, and bacteria in the mouth that lead to acid buildup and the decay of tooth tissues. Caries that eat through the first two layers of tooth tissue (enamel and dentin) can usually be fixed through normal fillings (decay is drilled out and replaced with a silver amalgam filling or a white composite filling). But when the decay has eaten through the third layer of tooth tissue (pulp) that contains blood vessels, nervous tissue, and other connective tissue, the patient must extract the tooth or get a root canal (drilling out of decayed pulp and sealing with a rubber like material called gutta-percha) and crown (a cap that covers the old crown of the tooth) to fix the tooth. In an article from the American Journal of Medicine, researchers have started utilizing dental mesenchymal stem cells (DMSCs) to create a scaffold capable of regenerating the dentin/pulp complex. DMSCs cannot be used clinically yet as the cells are not abundant in periodontal tissues, but as research progresses new methods may be found to obtain them. However, the idea of regenerating the pulp/dentin complex without using gutta-percha gives patients a new procedure to solve their decay issue. Instead of getting a crown after a normal root canal, patients with a regenerated dentin/pulp complex can just receive a filling to replace enamel tissue that was lost. The article shows us a glimpse of the promising near future of dental care as it gives patients more options to solve their problems!
Orsini, G., Pagella, P., & Mitsiadis, T. A. (2018). Modern Trends in Dental Medicine: An Update for Internists. The American journal of medicine, 131(12), 1425–1430. https://doi.org/10.1016/j.amjmed.2018.05.042
In regards to the early stages of caries formation, have you heard of sugar alcohols aiding in the remineralization of small enamel defects? According to this journal article, xylitol is a sugar alcohol that, if regularly consumed (usually in the form of chewing gum), can reduce caries. This was a consistent finding in many clinical trials. Perhaps if more patients knew about the beneficial effects of sugar alcohols, there would be a drop in patients needing root canals/tooth extractions?
ReplyDeleteMäkinen K. K. (2010). Sugar alcohols, caries incidence, and remineralization of caries lesions: a literature review. International journal of dentistry, 2010, 981072. https://doi.org/10.1155/2010/981072
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ReplyDeleteHello Anthony! It's interesting to read about DMSCs as an alternative treatment instead of getting a root canal and a crown which can be scary! I wonder how soon this will be transferred clinically someday and their implications. Do you see this as being able to replace root canals and crown? If it will become available, I think this treatment might take a while for it to be covered by insurance to replace traditional methods, making it more accessible for a more privileged set of population.
ReplyDeleteI also found an article by Li B, et al. which talks more about where the DMSCs come from, and apparently they come from MSCs from different parts of the mouth. Do you know if these DMSCs are taken from the patient for their own treatment or from someone else? This reminds me of bone-marrow transplant for cancer treatments. Thanks!
Article:
Li B, Ouchi T, Cao Y, Zhao Z, Men Y. Dental-Derived Mesenchymal Stem Cells: State of the Art. Front Cell Dev Biol. 2021 Jun 22;9:654559. doi: 10.3389/fcell.2021.654559. PMID: 34239870; PMCID: PMC8258348.
This is super interesting! Stem cells are quickly becoming one of my favorite topics in general, and seeing how they can be used to easily in dentistry is fascinating. According to this journal I found, it seems like it's not just the DMSCs that are needed to repair dental pulp, and they need bioactive material in order function correctly. In the study, they tested a variety of bioactive materials, with calcium phosphate yielding some of the best results when using in conjunction with DMSCs.
ReplyDeleteWhile both of these things seem great, they also mentioned possible issues since the bioactive material is still technically foreign, even if the stem cells are somehow obtained from the person themselves. Do you think that this could pose an issue to this technique?
Article:
B. Christie, N. Musri, N. Djustiana, V. Takarini, N. Tuygunov, M.N. Zakaria, A. Cahyanto, Advances and challenges in regenerative dentistry: A systematic review of calcium phosphate and silicate based materials on human dental pulp stem cells, Materials Today Bio, Volume 23, 2023, 100815, ISSN 2590-0064, https://doi.org/10.1016/j.mtbio.2023.100815.