Dental Associations: Oregon Dental Association
Companies working in the Oral Care Industry: Oragenics fertin Pharma (chewing gum for oral care)
Dental Cavities
I. Etiological agents and Pathological Mechanisms:
1. Bacteria:
–Streptococcus mutans (S. mutans): is the main etiological agent of dental caries (US 6,024,958). Strains of S. mutans are divided serologically into 8 types, a to h. Among these serotypes, serotype c strains are most frequently isolated form human dental plaque. S. mutans produces both water soluble and water insoluble polysaccharides from sucrose by the action of multiple forms of glucosyltransferase (GTase) and fructosyltransferase (FTase). The enzyme, glucosyltransferase decomposes sugars in foods, and generates water insoluble polysaccaride glucan. The glucan combines with the bacteria S. mutans and forms plaque (dental plaque) that adheres to the surface of the teeth. In the plaque, S. mutans metabolizes the sugar and generates acids such as lactic acid. The acid dissovles calcium from enamel of the surface of the teeth, resulting in dental caries (US 2009/0041782). Mutants of S. mutans lacking the ftf gene, have been shown to be less cariogenic than the native strains.
2. Dental plaque: is a biofilm coating tooth surfaces and is composed of bacteria, cells, proteins, enzymes, and their byproducts. One of the major virulence factors of cariogenic bacteria is their ability to produce extracellular polysaccharides, which facilitate their adhesion to tooth surfaces and act as a reservoir of nutrition for the bacteria.
–ß-D-Fructosyltransferases are among the cell free enzymes found in the oral cavity. FTF products fructans (polyfructoses) from sucrose, and these play a role in the pathogenicity and formation of the dental bioflim. The origin of these extracellular enzymes are several sepcies of oral bacteria included Streptococcus mutans, Streptoococcus salivarius, Streptococcus sanguis, and Actinomyces viscosus. Degradation of fructans by fructanase to fermentable sugars serves as a source for acid production by oral bacteria, thus inducing the cariogenic challenge in the oral cavity. Fructans may also serve as binding sites for oral bacterial in the dental plaque biofilm.
Cavity Protection/Treatment:
Dental caries is characterized by dissolution of the mineral portion of the tooth, which can result in pain and loss of viability of the tooth, necessitating costly report or extraction of the tooth. Various methods have been developed to prevent dental caries including the addition of sodium fluoride, sodium silicofluorideand hydrofluosilicic acid to drinking water and sodium fluoride or tin fluoride to topical preparations including mouth rinses. Coating teeth with polymeric materials or sealants has also been used although these techniques are costly, can require etching of the teeth with phosphoric acid and can be effective only in young children who have not yet developed caries.
–Antibacterial agents which kill microorganisms that are responsible for producing acid in the mouth has also been used. But antibiotics are not selective in the killing of oral bacteria and also kill benefiical bacterial present in the oral cavity.
—-Chlorhexidine (CHX) is one of the most potent antibacterial and antiplaque drug used in dentistry. It has been shown that CHX inhibits production of fructan synthesis by cell free FTF.exhelping to reduce swelling and redness of the gums and bleeding when you brush. idine is used along with regular tooth brushing/flossing to treat gingivitis a gum disease that causes red, swollen and easily bleeding gums. It works be creasing the amount of bacteria in the mouth.
Chlorhexidine (0.12% rinse) is used along with regular tooth brushing/flossing to treat gingivits, a gum disease that causes red, swollen and easily bleeding gums. Chlorhexidine belongs to a class of drugs called antimicroials. Chlorhexidine is also used to clean skin before surgery.
–Vacination: Lehner (US 6,024,958) discloses peptide subunits of S mutans antigen I/II which are useful to prevent and treat dental caries either by eliciting an immunological response or by preventing adhesion of S mutans to the tooth.
Tooth Whitening
tooth whitening (i.e., the removal of stains from teeth) is a multibillion dollar indsutry. Numerous approaches have been tried to whiten teeth, some of which are described below.
–use of abrasives: such as diatomaceous earth, silica and baking soda have been used to whiten teach. Abrasives are a major element of most toothpastes and prophylaxis pastes are used by dentists.
–Chemical whitening additives: are applied to the teeth to allow the active ingredient to whiten the teach. A common chemical whitening agent is peroxide. Often, strips and trays are used to apply peroxide for contact times beyond that achievable with typical tooth brushing. US 5,891,453 and 5,8i7,691 describe a whitening product comprising a peroxide composition. However, peroxides can cause soft tissue irritation.
–actinidin: Bergeron: (US 2007/0110682A1) discloses the active ingredient “actinidin” which is produced from kiwifruit for whitening teeth.
–strawberries and apples contain malic acid, a natural stain remover.
–The citric acid in limons can also brighten teeth.
–chewing on raw fruits and vetables,
–sugarless gum, See also fertin Pharma which has chewing gum products for oral care.
–avoid coffee, red wine and dark soft drinks or use a straw to reduce the liquid’s contact with teeth,
–brush with baking soda twice a month.
Tooth Brushes
Sonic Toothbrushes: In a 4 week clinical trial, the Sonicare sonic toothbrush was demonstrated to be superior to manual toothbrushes in improving periodontal health in patients with gingivitis (Ho, J. Clin. Dent., 1987, 8, 15-9).
Dental Implants:
Endosseous dental implants are successfully used to replace the missing teeth. Despite the predictability of success of dental implants, a small group of patients may experience implant failure. (Tabrizi, “The risk factors in early failure of dental implants: a retrospective study”J Dent Shiraz Univ Med Sci., 2017, 18(4): 298-303)
Factors Important in Success of Dental Implants:
Predictors of dental implant success are the quantity and quality of bone, the patient’s age, the dentist’s experience, location of implant placement, lenght of the implant, axial laoding and oral hygiene maintenance. Primary predictors of implant failure are poor bone quality, chronic periodontitis, systemic diseases, smoking, unresolved caries or infection, advanced age, implant location, short implants, acentric loading, an inadequate number of implants and absence/loss of implant integration with ahrd and soft tissues. (Fraunhofer, “Success of failure of dental implants” A literature review tih treatment considerations” General Desntisty, November/December 2005).
–Infection: The presence of infection may have a role in implant failure. Typically, implant failures have been observed when pathology is at or within close proximity to the imlant site (for example, placement in an infected tooth socket), adjacent to an undiagnosed endodontically involved tooth, adjacent to an existing lesion (such as a cyst), or when periodontitis is prsent. Immediate implant placement (that is, an implant placed into a fresh socket after tooth removal) may have a poor prognosis if extraction was necessitated by infection or perio-dontal disease. Ideally, in the presence of infection, palcement of the implant will be dealyed. If not possible,, preoperative antibiotic therapy icnlduing antibiotic lavage of the site, hand instrumentation of the implant site to remove affected bone and postoperative antibiotic cvoerage in combiantion with the daily use of chlorhexidine gell during the entire healing period may improve the clinical. outcome. The reproted success rate for implants placed in grafted bone has ranged form 77-85%. by contrast, cimplants placed in mature ungrafted bone have a success rate of 95% or mroe. Fraunhofer, “Success of failure of dental implants” A literature review tih treatment considerations” General Dentisty, November/December 2005).
–Timing of the placement of dental implants in grafted bones: is critical. Grafted bone must have itme to integrate and mature to a highly organized structure. Immature bone cannot be expected to withstand the torque inherent in dental implants while its repalcement lamellar obne takes time (6-12 months) to evolve. By contrast, lamellar bone has a mroe organized sturcture, pvoding greater implant to bone contact and offering a better prognosis. Fraunhofer, “Success of failure of dental implants” A literature review tih treatment considerations” General Desntisty, November/December 2005).
–Surface of dental implants is a key factor in bone-implant contact and the spped of bone apposition around the implants. Among various types evaluated in one study, the highest failure rate was noted in RBM series and the lowest in calcium phosphate coated implants.(Tabrizi, “The risk factors in early failure of dental implants: a retrospective study”J Dent Shiraz Univ Med Sci., 2017, 18(4): 298-303)
–Prophylactic antibotic treatment resulted in a better success rate according to one study. A higher failure rate in patients who did not receive prophylactic antibiotics (44.6% versus 4.6%).
(Tabrizi, “The risk factors in early failure of dental implants: a retrospective study”J Dent Shiraz Univ Med Sci., 2017, 18(4): 298-303)
–Age: Some beleive that there is an increased risk of failure for pateints over 60. Others suggest that age has a minor effect and is non-contributory to dental implant failure. Fraunhofer, “Success of failure of dental implants” A literature review tih treatment considerations” General Desntisty, November/December 2005).
–Oral habits: The most common patient habits that adversely affect dental implants are bruxing and smoking, although parafunctional activites such as chewing ice and nibbling on hard objects may cuase premature implant failure. Habitual bruxing increases the horizontal stress on implants; even aggressive tongue thrusting may cause problems with anterior implants. Bruxing is not a positive force even for natural teeth becasue the dental implant is osseointegrated (that is, anchored into the mandible or maxilla by the bone itself). Fraunhofer, “Success of failure of dental implants” A literature review tih treatment considerations” General Desntisty, November/December 2005).