Can Antibacterial Fillings Combat Recurring Tooth Decay?

Researchers at Tel Aviv University have found potent antibacterial capabilities in dental restoratives – also known as filling materials. The resin-based composites - with the addition of antibacterial nano-assemblies - can hinder bacterial growth and viability on dental restorations, the main cause of recurrent cavities, which can eventually lead to root canal treatment and tooth extractions. "Antibiotic resistance is now one of the most pressing healthcare problems facing society, and the development of novel antimicrobial therapeutics and biomedical materials represents an urgent unmet need," says Dr. Lihi Adler-Abramovich. "When bacteria accumulate on the tooth surface, they ultimately dissolve the hard tissues of the teeth. Recurrent cavities - also known as secondary tooth decay - at the margins of dental restorations results from acid production by cavity-causing bacteria that reside in the restoration-tooth interface."

Tooth decay is among the costliest and most widespread bacterial diseases. Virulent bacteria cause the acidification of tooth enamel and dentin, which, in turn, causes secondary tooth decay. This disease is a major causative factor for dental restorative material failure and affects an estimated 100 million patients a year at an estimated cost of over $30 billion. Historically, amalgam fillings composed of metal alloys were used for dental restorations and had some antibacterial effect, but due to the alloys' bold color, the potential toxicity of mercury and the lack of adhesion to the tooth, new restorative materials based on composite resins became the preferable choice of treatment.

The lack of an antimicrobial property remained a major drawback to their use. "We've developed an enhanced material that is not only aesthetically pleasing and mechanically rigid but is also intrinsically antibacterial due to the incorporation of antibacterial nano-assemblies," added Lee Schnaider, TAU doctoral student. "Resin composite fillings that display bacterial inhibitory activity have the potential to substantially hinder the development of this widespread oral disease."

These scientists are the first to discover the potent antibacterial activity of the self-assembling building block Fmoc-pentafluoro-L-phenylalanine, which comprises both functional and structural subparts. Once the researchers established the antibacterial capabilities of this building block, they developed methods for incorporating the nano-assemblies within dental composite restoratives. They evaluated the antibacterial capabilities of composite restoratives incorporated with nanostructures as well as their biocompatibility, mechanical strength and optical properties. "This work is a good example of the ways in which biophysical nanoscale characteristics affect the development of an enhanced biomedical material on a much larger scale," Schnaider says.

"The minimal nature of the antibacterial building block, along with its high purity, low cost, ease of embedment within resin-based materials and biocompatibility, allows for the easy scale-up of this approach toward the development of clinically available enhanced antibacterial resin composite restoratives," Adler-Abramovich added. The researchers are now evaluating the antibacterial capabilities of additional minimal self-assembling building blocks and developing methods for their incorporation into various biomedical materials, such as wound dressings and tissue scaffolds. The researchers were from TAU's Maurice and Gabriela Goldschleger School of Dental Medicine and George S. Wise Faculty of Life Sciences and the study was published in ACS Applied Materials & Interfaces.

Dental Filling Failure Linked To Smoking, Drinking And Genetics

Research shows that people who drink alcohol or men who smoke are more likely to suffer a failed dental filling. And, a genetic difference in some patients is associated with increased filling failure rates. The study - published in the journal Frontiers in Medicine - also shows no major difference in filling failure rates between traditional amalgam and newer composite resin fillings. The results suggest that genetic analysis might help dentists to personalize treatments for their patients, which could lead to improved outcomes.

Fillings can fail for a variety of reasons, including reemergence of the initial tooth decay or the filling becoming detached. Until this research, it was not known whether newer composite resin fillings are as durable as traditional amalgam fillings, which have been in use for more than 150 years but which contain the toxic metal mercury. The researchers accessed a large repository of dental records from a dental school in Pittsburgh, Pa. which contained information on patient fillings and rates of failure up to five years after the filling procedure.

They found that overall, there were no major differences between patients receiving amalgam or composite fillings in terms of filling failure rates. This suggests that composite fillings are at least as durable as amalgam fillings, and offer a viable alternative with no toxic ingredients. The repository also contained information about patient lifestyles, including smoking and drinking habits, and a DNA sample from each patient, which allowed the team to investigate whether patient lifestyle and genetic factors could affect the failure rate of composite fillings.

Within two years of the procedure, fillings failed more often in patients who drank alcohol, and the overall filling failure rate was higher in men who smoked. A difference in the gene for matrix metalloproteinase (MMP2), an enzyme found in teeth, was linked to increased filling failure. The researchers hypothesized that MMP2 might be able to degrade the bond between the filling and the tooth surface, potentially leading to failure. While this link and preliminary hypothesis are intriguing, the researchers have not yet confirmed whether differences in the MMP2 gene are responsible for failed fillings, and will need to investigate this further.

The results suggest that personal factors for each patient appear to influence their chance of filling failure, rather than the filling material their dentist used. "A better understanding of individual susceptibility to dental disease and variation in treatment outcomes will allow the dental field to move forward," added Alexandre Vieira, a researcher involved in the study. "In the future, genetic information may be used to personalize dental treatments and enhance treatment outcomes."

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