The Fight Against Tooth Decay Gets Help With A New Smart Material

When patients go to the dentist to fill a cavity, they’re trying to solve a problem – not create a new one. But many dental patients get some bad news: bacteria can dig under their tooth-colored fillings and cause new cavities, called recurrent caries. These recurrent caries affect 100 million patients every year and cost an additional $34 billion to treat.

Now, a research collaboration between the Department of Materials Science & Engineering, Faculty of Dentistry, and the Institute of Biomaterials and Biomedical Engineering at the University of Toronto has resulted in a novel way to minimize recurrent caries.

In a recent paper published in the journal Scientific Reports, professors Ben Hatton, Yoav Finer and Ph.D. student Cameron Stewart tackled the issue and proposed a novel solution: a filling material with tiny particles made by self-assembly of antimicrobial drugs, designed to stop bacteria in its tracks. These particles may solve one of the biggest problems with antibacterial filling materials: how do you store enough drug within the material to be effective for someone’s entire life?

Fighting Cavity-Causing Bacteria

“Adding particles packed with antimicrobial drugs to a filling creates a line of defense against cavity-causing bacteria,” says Hatton. “But traditionally there’s only been enough drug to last a few weeks. Through this research we discovered a combination of drugs and silica glass that organize themselves on a molecule-by-molecule basis to maximize drug density, with enough supply to last years.” This discovery of using antimicrobials which self-assemble means the team can pack 50 times as much of the bacteria-fighting drugs into the particles.

“We know very well that bacteria specifically attack the margins between fillings and the remaining tooth to create cavities,” says Finer. “Giving these materials an antimicrobial supply that will last for years could greatly reduce this problem.”

Looking ahead, the research team plans on testing these new drug-storing particles in dental fillings, monitoring their performance when attacked by bacteria and saliva in the complex environment in the mouth. With some fine-tuning, this new “smart” material could create a stronger filling and fewer trips to the dentist.

What Causes Tooth Decay?

Photo of Teeth and a Dental Probe.  Dental Concept
Photo of Teeth and a Dental Probe. Dental Concept

Tooth decay is the presence of a cavity or cavities that exist in your mouth and aren’t properly treated for a period of time. Decaying or decomposition of the tooth occurs when bacteria that is present in your mouth starts to make acid, which begins to erode and eat away at the tooth itself. If tooth decay is left untreated for too long, it will cause an infection which generally leads to severe pain and then the loss of the tooth. The way that tooth decay starts to affect the tooth is from the outside in. It first targets the enamel of the tooth and then progresses to the deeper layers, which includes the pulp. This is where the sensitive nerves and blood vessels are. Here are some of the most common causes of tooth decay.

Improper Nutrition

If you have a very poor diet, you are more susceptible to dealing with tooth decay. Foods that are high in sugar or acid can be very harmful to the tooth. This is because sugar is a great platform for bacteria to grow from. Sugar can help bacteria to fester and even turn certain sugary chemicals into acid. This is also the case with many acidic foods and drinks like specific fruits and soda. Most people are shocked to learn that certain foods that are actually healthy for the body are unhealthy for the teeth. In order to ensure a healthy, beneficial diet for your teeth, eliminate both sugar and acid from your daily consumption.

Poor Oral Hygiene

So many cases of tooth decay are directly linked to simply not taking care of the teeth and mouth. Brushing regularly is not optional. You must ensure that you are brushing your teeth thoroughly at least twice a day and flossing on a regular basis as well. Some people don’t realize that brushing requires focus and attention to detail. You must brush for at least two full minutes, targeting every angle of your teeth. Improper oral hygiene is the leading cause of tooth decay. Take care of your teeth or it will potentially cause you a mountain of bills and pain later on in life.

Dry Mouth

If you suffer from dry mouth due to lack of hydration or medication, this can be something that is contributing to your tooth decay that you aren’t even aware of. This is because saliva naturally helps to inhibit the growth of plaque. If you have a problem with saliva production, you are leaving your teeth more susceptible to tooth decay because over time the plaque in your mouth will continue to grow and become even more of a problem thus leading to the erosion of your teeth.

Tooth Grinding

There are so many people who suffer from the misfortune of grinding their teeth. This typically happens when they are asleep or have incredibly stressful lives. Making sure to properly manage stress will help mitigate this issue, however, opting for a night guard or mouth piece can help to correct the issue all together. The grinding leaves the teeth enamel broken down and more apt to fall victim to bacteria that decays teeth.

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The Impact Of Liquid Diets On Your Teeth

liquid diets teethLiquid diets are all the rage. We’re bombarded daily with advice on how juicing can cleanse the body, the benefits of protein shakes as meal replacements, and even drinking tea to keep sickness at bay. While liquid diets do have value, they can be destructive to the teeth if you’re not careful.

“The biggest problem with liquid diets is the act of bathing your teeth in a liquid all day – they can be especially harmful if the liquid is acidic or has added or natural sugar,” said Cherri Kading, R.D.H., M.S., director of clinical operations at Texas A&M University Baylor College of Dentistry. “Tooth decay and erosion of tooth enamel are the biggest concerns associated with liquid diets.”

Like the name suggests, a liquid diet is when the majority of a person’s calorie intake comes from drinking liquids. Some liquid diets are limited to fruit or vegetable juices, or even shakes that replace all of your meals. While many liquid diets are personal choices, some need medical supervision.

Certain liquid diets like juicing do have related health benefits, but Kading emphasized some fruits are better than others for your teeth. “Apples, pineapples and grapes have more sucrose than fruits like berries and pears,” she said. “Fruits are good for us, but we need to be mindful of how much sugar we’re exposing the mouth to.”

Watch The Sugar Content

According to Kading, sugar and acids are some of the leading culprits behind tooth decay. “Sports drinks, soft drinks, and even some fruit juices are extremely acidic,” she said. “If you drink these chronically they can cause erosion, which is like a ‘melting away’ of the enamel. Sugar content in these drinks is troublesome, too, because sugar feeds the bacteria that live on the teeth and eventually causes decalcification – the beginning process of a cavity.”

The amount of liquid and how often we drink it per day is also key. “We need to ask ourselves how often are we drinking our tea, coffee or soft drinks,” Kading said. “If you’re constantly sipping on something that contains sugar or acid, your mouth never has time to recover from the effects these ingredients may cause. Saliva is what neutralizes the mouth, and it’s important to give the mouth a break from both acid and sugar so the saliva can do its job.”

Worth noting, water is the only liquid acceptable to sip all day. Kading stressed those who partake in liquid diets should always be drinking water along with any other liquids. “If you’re drinking water, this will help dilute, flush and cleanse the mouth,” she said.

If you’ve recently had oral or jaw surgery, liquids may be your only nutrient option – at least for a little while. Kading said health care professionals should always educate their patients on the cavity process, so they understand why proper care of the teeth is essential while on a liquid diet.

“You can’t just send the patient off with a special toothbrush or floss and tell them to use it. You have to tell them why it’s important,” she said. “If the patient doesn’t understand the ‘why’ behind proper oral care during a liquid diet, they are likely not to stick with their oral care regimen. Patients need to know not to sip on acidic drinks, to watch sugar intake and always rinse with water.”

But, don’t think liquid diets are all bad for the mouth. “There can be some benefits to liquid diets,” Kading said. “One is that liquids wash over your teeth and are easily rinsed out with water. The best way to approach a liquid diet is drink your shake or juice, rinse with water and then be done with it. The real harm lies in sipping on drinks and keeping your mouth awash in acids and sugar all day.”

Teeth Strengthening: Here’s A Few Ways That Can Help

teeth strengtheningThough many often talk about the importance of having a healthy body, and taking care of it with consistent diet and exercise, sometimes the ways in which we can strengthen our teeth and our mouth by extension are overlooked. But make no mistake, the health and appearance of the teeth and mouth are equally important. There is a myth, that many of us grew up with, that supposes teeth can only be strengthened in adolescence. This is simply not the case. There are a few ways in which we can ensure that our teeth get stronger instead of the opposite.

It’s important to understand that the fundamental strength of teeth is based predominately on the chemistry of the mouth. This means that how we treat and care for our teeth on an everyday basis affects how strong our teeth are. Tooth decay is the result of bacteria. This happens when there is an excess of plaque that forms around the tooth. Decay is often increased and perpetuated in those who consume a lot of sugar. The saying about candy rotting out the teeth and not being good for the mouth are unfortunately very true. Sugar can erode and wreck havoc on the enamel of the tooth, causing it to weaken and be more susceptible to loosening and potentially falling out.

Consistent dental care is a way to combat the effects of a bad diet, but it won’t be completely effective as a preventative measure. It’s obvious that you should be brushing your teeth at least twice daily, and flossing at least once, to keep your teeth in the best possible shape. It’s also advised to rinse with a mouthwash that kills harmful, plaque-causing bacteria.

Another way to strengthen teeth is to consume foods and drinks that naturally aid in that process. Just as foods with a high sugar content aren’t good for the teeth, there are foods that can prove to be beneficial and have the opposite effect. Green tea is great for teeth, as it is rich in an element called catechin polyphenols, which is a natural bacteria killer. This is an easy way to eliminate harmful bacterial that leads to tooth decay and gum disease.

Two other great beverages that help strengthen teeth are red wine and cranberry juice. This may seem counterintuitive for some people because of their dark, rich color and their propensity to stain teeth, but they are actually great aids for teeth strength. Foods rich in calcium are also known to be recommended for the strengthening of teeth. After all, teeth are just bones and we all know how important calcium is to strong and vital bones!

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How To Eliminate Pain Tied To Tooth Decay

tooth decay painDual discoveries at USC propose a promising method to regrow nonliving hard tissue, lessening or even eliminating pain associated with tooth decay, which the National Institutes of Health calls the most prevalent chronic disease.

Janet Moradian-Oldak, a professor at the Herman Ostrow School of Dentistry of USC, has investigated methods to regrow tooth enamel for the past two decades. The process is especially tricky because unlike bone, mature enamel cannot rejuvenate. Tooth enamel is a nonliving tissue.

The a-ha moment came Oct. 22, 2015 when, in collaboration with lead author Sauma Prajapati of USC and other colleagues, she published a study in the Biomaterials journal saying matrix metalloproteinase-20, an enzyme found only in teeth, chops up amelogenin proteins, which facilitate organized enamel crystal formation. MMP-20 clears the way for hard material to usurp vacated space.

Her team is the first to define the function of an enzyme for preventing protein occlusion inside a crystal, she said.

“MMP-20 is released at a very early stage of enamel formation,” said Moradian-Oldak, the study’s senior author. “MMP-20 chops up proteins during the crystallization of enamel. Together with other enzymes, it gets rid of ‘sludge’ so the enamel making cells in the body can add more mineral and make enamel, the hardest bioceramic in the human body.”

Dental Restoration

Moradian-Oldak will couple the MMP-20 discovery with another study published Nov. 2, 2015 in the Journal of Biomedical Engineering and Informatics, which concluded an amelogenin-chitosan hydrogel could repair early tooth decay by growing an enamel-like layer that reduces lesions by up to 70 percent.

“Recognizing MMP-20’s function in biomineralization is one of the first steps to learning how dental enamel forms in nature,” said Qichao Ruan, lead author of the hydrogel study and a postdoctoral research associate in the Center for Craniofacial Molecular Biology at USC. “The findings regarding MMP-20 not only help us to further understand the mechanisms of enamel formation but they also can be applied in the design of novel biomaterials for future clinical applications in dental restoration or repair.”

The Food and Drug Administration has not yet approved any type of enamel regrowing gel. USC is in pre-clinical trials. Moradian-Oldak said one day people may be able to use an overnight mouth guard or teeth strips saturated with hydrogel to regrow enamel-like substances and reduce teeth sensitivity.

Finding The Right Fix

Products such as toothpaste and mouthwash containing fluoride and casein phosphopeptide-amorphous calcium phosphate promote remineralization of initial enamel lesions, however, they need to be used regularly and are more of a tire patch than a real solution, Moradian-Oldak said. It plugs up the problem so people don’t feel pain. The gel, however, fills the cracks and holes with an enamel-like substance.

In the United States, 92 percent of adults aged 20 to 64 have had dental decay in their permanent teeth, Moradian-Oldak said. Grinding teeth at night, gum recession and the disappearance of enamel over a lifetime due to demineralizing acidic food and drink are all common problems people everywhere face.

When tested in an environment that mimics an oral cavity’s biochemical processes, the gel created a robust attachment, eliminating the threat of secondary cavities in the same spot, Ruan said. The gel could be more effective than traditional crowns, whose adhesion weakens over time, he added.

“Besides biocompatibility and biodegradability, the gel has unique antimicrobial and adhesion properties that are important for dental applications,” Ruan said.

UW Study Shows Natural Sweetener Xylitol Can Prevent Tooth Decay

As a natural sweetener, xylitol has been used in chewing gum and mints for years upon years. Recent studies from the University of Washington have shown more positive benefits to the sugar compound than previously imagined. Many people have believed in the propoganda of fluoride for years in cavity prevention, even though studies have also shown it to weaken enamel. This new study shows that the use of pure xylitol can be just as, if not more effective in the prevention of dental caries.

Especially in low income, low educational areas xylitol may very well be a cheaper alternative to preventing tooth decay, which plagues these areas more so than others. Dr. Peter Milgrom has conducted a small test using xylitol syrup with babies which has shown a significant reduction in the number of babies developing cavities. A concentrated dose, multiple times daily is the key to success with this, and it may very well become a part of standard dental care and preventative dentistry.