Unconventional Dental Treatment Presented By Riham Mohamed Aly

Unconventional Dental Treatment Presented By Riham Mohamed Aly Unconventional Dental Treatment 1

Unconventional Dental Treatment o o o It’s an alternative way of treatment other than what we usually think of when confronted with dental problems. The majority of the treatment modalities are drill and fill , but the alternatives are actually various thanks to the scientific advances which is now directed to lesion specific approach. The purpose of this study is to present and evaluate the available modalities from the most basic practices to the far more sophisticated scientific technology. Unconventional Dental Treatment 2

So What Are The Alternatives? 1 - Unconventional medicine 2 - Biological Dentistry 3 - Vaccines 4 - Tooth Regeneration Unconventional Dental Treatment 3

1 - Unconventional Medicine o o o These diagnostic and treatment approaches have been variously described as “Alternative”, “Integrative” , “Environmental”, “Complementary” The ADA describes it as encompassing scientifically unproven practices and products that do not conform to the generally accepted dental practice. It is characterized by the lack of sufficient documentation on their safety and effectiveness also its absence from the dental curriculum. Unconventional Dental Treatment 4

The Unconventional Care Patient: The reason for the Popularity and the increasing use of UD is complex , it may be due to the fact that patients seek new hope or because it less invasive and appear to be safer than conventional treatment Unconventional Dental Treatment 5

Classification Of UD I- Alternative medical systems a- acupuncture b- homeopathy II- Biologically based dental therapies a- phytotherapy or herbalism b- natural and synthetic dental products III- Biofield Through the use of subtle energy fields in and around the body. IV- Bioelectromagnetics Using electromagnetically fields for dental & medical purposes e. g. wearing magnetic rings for TMJ problems & arthritis. Unconventional Dental Treatment 6

Unconventional medicine Acupuncture • It describes a range of procedures that stimulate certain points on or near the skin based on the ancient Chinese medical philosophy that the disruption of a normal pattern of energy flow is responsible for the disease. • The dental application is mainly for Pain Relief , but due to the danger of chocking when using needles in the oral cavity , local injection of saline or local anesthetic in these points is performed. Unconventional Dental Treatment 7

Unconventional medicine Homeopathy • The principles of homeopathy include the belief that disease presents a disturbance in the body’s ability to heal itself. • Dental promotions for homeopathy range from treatment of fear and anxiety, TMD, facial paralysis, aphthous ulcers, toothache, infections , halitosis and periodontal disease • “Remedies” are determined by noting the symptoms produced by large doses of a substance in a healthy individual and applying these substances in highly diluted doses to relieve the same symptoms Unconventional Dental Treatment 8

Unconventional medicine Phytotherapy or Herbalism • Herbal medicine uses drugs of plant origin to treat disease or maintain condition of improved health. • Some conventional drugs like morphine are originally extracted from plants • In dentistry clinical trial of producing herbal mouthwash in preventing oral mucositis from chemotherapy • Also it is largely used in formulating mouthwashes and toothpastes • It is also promoted sometimes as vitamins and mineral supplements Unconventional Dental Treatment 9

ADA positions and statements: (Policy Statement On UD) o o This is the statement published by the ADA on the subject of UD “The ADA consistent with its object to encourage the improvement of the health of the public and to promote the art and science of dentistry supports those diagnostic and treatment approaches that allow both patient &dentist to make informed choices among safe and effective options. The ADA encourages advocates of UD to pursue scientifically valid systematic assessment of treatment efficacy and safety” Unconventional Dental Treatment 10

So What Are The Alternatives? 1 - Unconventional medicine 2 - Biological Dentistry 3 - Vaccines 4 - Tooth Regeneration Unconventional Dental Treatment 11

2 - Holistic Or Biological Dentistry o o o It adopts a humanistic philosophy considering the whole patient including both physiological and behavioral disorders. It is remote from scientific practice and is used to treat chronic conditions that can not be cured by scientific dentistry. This is done by saving all healthy tooth structures and using bioenergetic medicine including: n n n Neural Therapy Cold Laser Mouth Balancing and Nutrition Unconventional Dental Treatment 12

2 - Holistic Or Biological Dentistry o o o It adopts a humanistic philosophy considering Neural Therapy the whole patient including both physiological • It claims that when and behavioral disorders. inflammation or infection is present from in thescientific mouth, there is and is used It is remote practice usallychronic blockage in the body's to treat conditions that can not be curednormal by scientific energydentistry. flow, since every cell possess its own specified This frequency is done range by saving all healthy tooth structures and using bioenergetic medicine • Injection of LA around the tooth including: in question n Neural Therapy to remove the energy n Cold Laser blockage will resolve the problem n Mouth Balancing and Nutrition Unconventional Dental Treatment 13

2 - Holistic Or Biological Dentistry o o o It adopts a humanistic philosophy considering Cold Laser the whole patient including • It is an alternative formboth of physiological and behavioral disorders. accupunture for patient who refuse needles. It is remote from scientific practice and is used • It is chronic supposed to kill bacteria & to treat conditions that can not be aid wound healing and treat cured byinscientific dentistry. TMJ dysfunction. This • The is done saving all light healthy tooth powerby output and the structures andused using bioenergetic spectrum doesn’t cause any medicine including: thermal damage thus called n Neural Therapy “cold “ n Cold Laser n Mouth Balancing and Nutrition Unconventional Dental Treatment 14

2 -Holistic Or Biological Dentistry (cont. ) o o Biological dentistry is different from UD that it is not based on scientific research in fact unconventional dentistry practioners do not approve of it. It is only mentioned in this presentation so as not to confuse between it and the UD , especially with the spread of information that is not usually reviewed especially over the Internet. Unconventional Dental Treatment 15

Amalgam/Mercury Toxicity Controversy : o o Among the major promotions of biological dentists is amalgam toxicity They claim that the amalgam being used as a filling is very toxic to the body and is the cause of many diseases and demand that every filling should be removed The World Health Organization in reply to these claims stated that the overall toxic risk of amalgam is very low and that the removal of any filling on the ground that health may improve as a result is unethical The ADA also produced a statement with the same meaning Unconventional Dental Treatment 16

So What Are The Alternatives? 1 - Unconventional medicine 2 - Biological Dentistry 3 - Vaccines 4 - Tooth Regeneration Unconventional Dental Treatment 17

3 - Vaccines o o The possibility of developing a caries specific vaccine became possible with the identification of specific micro organisms associated with the etiology of caries All studies have been directed towards acid production ignoring that the glucans produced by bacteria plays an important role , since caries is a “dieto-bacterial“ disease. Unconventional Dental Treatment 18

3 - Vaccines (cont. ) o o o It is important to know here that the main causing microorganisms are the streptococcus mutans The purpose is not to strengthen the enamel but preventing either the action or the colonization of the tooth causing bacteria The immunization results in the elevation of antibodies against the products of the Strept. Mutans specially Glucans and Glucosyltransferase Unconventional Dental Treatment 19

o o o Glucans function in plaque accumulation and in strengthening the attachment of the microorganisms to the tooth surface. Glucosyltransferasse is the enzyme that synthesize glucan. The antibody created by the vaccine binds to the and prevents it from making glucans that cause bacteria to colnize and accumulate on the tooth surface. Unconventional Dental Treatment 20

Criteria to be considered: o o o Is there evidence that the immunization will work ? What will be the microbial target? Which component of the immune system will be targeted ? Unconventional Dental Treatment 21

Evidence that the anti-caries vaccine will be effective: o o Several studies indicated that it is possible to protect lab animals against caries The results of these studies is shown in this table: i) protection against smooth surface caries is very high in contrast to pits and fissure caries. ii) It also shows different effects based on location Unconventional Dental Treatment 22

What will be the microbial target? o o Immunization against whole cell S. mutans seems appealing but unfortunately Smutans posses antigens which are cross reactive with heart muscles therefore it is not accepted as an antigen. Other alternatives are: i) purification of candidate Ag and using subunit vaccine which are Glucans and glucosyltransferase. ii) Recombinant DNA method to place virulence factors from cariogenic organisms into a noncariogenic non reactive bacterium. Unconventional Dental Treatment 23

DNA vaccines o o Encouraging results were reported for DNA vaccine whereby DNA coding for the foreign antigen is directly injected into the animal so that the foreign Ag is directly produced by the host cell. Therefore it would be extremely safe and devoid from side effects since the foreign Ag is produced by the host. In addition DNA vaccine is relatively inexpensive and is easier to produce than conventional vaccines. Also the time for development is relatively short and it also results in more long term and stable than traditional vaccines. Unconventional Dental Treatment 24

Which component of the immune system will be targeted ? o o o There is a difference in opinions regarding whether Ig. G or Ig. A is responsible for the defense mechanism. Ig. A is the dominant immunoglobulin in the mouth and is resistant to protease and is the mucosal immunoglobulin therefore it may be effective against smooth surface caries. Ig. G is found in low conc in the saliva but in high conc in sulcular area and is susceptible to proteases it is effective against root caries. Unconventional Dental Treatment 25

How and When it is introduced ? o o o This vaccine triggers immunity in saliva and mucous tissue , therefore it swabbed into the nostrils. The best age is at one , after the deciduous teeth have erupted and before the mutants bacteria have started to increase in number. Also a booster dose can be given after the permanent teeth have erupted to provide life long immunity. Unconventional Dental Treatment 26

Active and Passive Immunization o o Active immunization is the previous method discussed , requiring subunit vaccines to avoid cross reactivity as mentioned before. Passive immunization either through Maternal or Xenogenic immunization( cows will be immunized against cariogenic bacteria and Ab will appear in the milk). Unconventional Dental Treatment 27

So What Are The Alternatives? 1 - Unconventional medicine 2 - Biological Dentistry 3 - Vaccines 4 - Tooth Regeneration Unconventional Dental Treatment 28

4 - Whole tooth regeneration o o o Last but not least is the tooth regeneration. Although the day when dentists will be able to build new teeth is still a few years away , the Bioengineering researches claim that dentures will be replaced with patients own teeth regenerated from tissue sample , where the ultimate goal is to grow it in same place of the missing tooth. Scientists claim that we are getting to closer to the era of replacement body parts instead of prosthetics. Unconventional Dental Treatment 29

Tooth Regeneration &Biomimetic o o o Biomimetic is science that tries to mimic biological structures, function and synthetic pathways to create a material that will resemble to some degree the original structure in this case a tooth. The main idea behind tissue regeneration is to employ the use of Multipluripotent Stem cells harvested from the pulp. Then loading it to a scaffolding which allows for their stable transfer into the target where they can grow to form dentin. Unconventional Dental Treatment 30

Tooth regeneration and Biomimetics (cont. ) o o o The identification of genes and genes products of enamel formation (amelogenin, ameloblastin) made it possible for enamel regeneration which due to its complex constituents was still far from regeneration. So far this has worked on immunosuppresed mice but not yet in humans. Another success is the regeneration of whole tooth using pigs (a second mammalian species) which gives hope to its application on humans. Unconventional Dental Treatment 31

Important information that needed to be discovered o o o What cells involved in forming the various parts of the tooth ? Also how these cells communicated with each other ? What genes were involved with the development ? Unconventional Dental Treatment 32

Three key element for Regenerative Dentistry o A) Inductive Morphogenetic signals (morphogenes ) q B ) Stem Cells q C ) Extra cellular matrix scaffold Unconventional Dental Treatment 33

Three key element for Regenerative Dentistry Unconventional Dental Treatment 34

A ) Inductive Morphogenes o o Morphogenes : are extracellularly excreted signals governing morphogenesis during epithelial mesenchymal interaction. They govern patterning and morphogenesis of teeth and associated PD structures. With the appropriate use of Morphogenes and stem cells with the appropriate scaffold dental tissue will be gained. Four distinct families of morphogenes are involved in embryonic morphogenesis. Unconventional Dental Treatment 35

A) Inductive Morphogenes (cont. ) o o But Bone morphogenic proteins seem to be sufficient in dental tissue engineering. BMP play the following role in craniofacial development: • Have a role in mesenchymal diffrentiation. • Associated with the diffrentiation of ameloblasts and odontoblasts. • It was present in the pulp during odontoblast development. Unconventional Dental Treatment 36

B) Stem Cells o o o Stem cells are: Cells that can differentiate into many different cell types when subjected to the right biochemical signals. The most versatile stem cells, called pluripotent stem cells, are present in the first days of embryonic development. Researchers believe they can control stem cells to become whatever tissues patients need. Stem cells come from embryos, bone marrow and umbilical chords Unconventional Dental Treatment 37

B) Stem Cells (cont. ) o Stem cells have two notable characteristics: - They divide and multiply rapidly—and they can keep on dividing for a long time. (Most cells in adult tissues are permanent— they no longer grow and divide). -They can differentiate, or become different types of tissue, such as heart muscle, nerves, or blood components. Unconventional Dental Treatment 38

B) Stem Cells (cont. ) o o Stem cells are present in dental pulp and PDL Recent studies also report their presence in exfoliated deciduous human teeth and porcine third molar tissue. No one had ever looked for stem cells in teeth before, because no one expected stem cells in teeth. That's because, unlike bone, teeth never grow bigger or repair themselves When transplanted in immunocompromised mice they gave rise to dentin like structures which proved that the pulp contained stem cells. Unconventional Dental Treatment 39

C) Extracellular Matrix or Biomimetic scaffold o o o Tissue engineering of teeth and associated tissues requires the scaffolding of the extracellular matrix be finely duplicated. The extracellular matrix usually includes collagen, and non collagenous glycoprotiens. The extracellular matrix scaffolding is a critical component to odontoblast diffrentiation and tubular dentin formation Unconventional Dental Treatment 40

C) Extracellular Matrix or Biomimetic scaffold o o o The methods used to sterlize the scaafold and the dose of irradiation profoundly affects the outcome Also the geometry of the scaffold play a role in determining the outcome Role of extracellular matrix : i) to hold active morphogenes together to confer the optimal conformation during morphogenesis. ii) protect from proteolysis. iii) it modulates the interaction between the inductive signaling by morphogenes and the responding cells. Unconventional Dental Treatment 41

Regeneration of dentin pulp complex o o o Together the role of morphogenes in inductive epithelial-mesenchymal interaction in tooth development, and the effects of the matrix on the stem cells regenration of dentin pulp complex is acheived. In vivo studies showed that BMP deleivered in a scaffold of decentralized dentin induced classic tubular dentin. But when used on collagen matrix osteodentin was induced. Unconventional Dental Treatment 42

Regeneration of the dentin pulp complex o o o The size and shape of the inductive material controls the size and shape of the repartive dentin formed. The reparative dentin initially appears with cellular and soft tissue inclusions , then changes into a more tubular form of matrix with odontoblast like cells attached to a mass of a tubular matrix. Optimally engineered reperative dentin may consist of osteodentin and tubular dentin , where tubular dentin is critical for tooth function including resistance to caries. Unconventional Dental Treatment 43

Conclusions o o Further work is still needed to be done to 1) characterize the stem cells involved in the development of dental tissue. 2) mapping of their differentiation. pathways. 3) determining the role of local conditions such as the type of scaffold and the presence of the microflora. The development of whole tissue engineered tooth though possible is still some way off from now. Unconventional Dental Treatment 44

Thank You Unconventional Dental Treatment 45