Changing the way dentistry is delivered: novel treatments and therapies
Hamde Nazar, Abdullah Nazar and Ali Nazar take a look at some of the latest dental products and therapies on the market, some of which are available in pharmacies
Community pharmacists are familiar with dental prescriptions and the range of dental products available in pharmacies. This article aims to highlight the latest dental products that are changing the way dentistry is delivered.
Tooth decay management
Evidence-based dentistry has caused a paradigm shift from the “drill-and-fill” days to practising minimally invasive (MI) dentistry. In the past, management of tooth decay involved either removal of the decay, by drilling and then filling the resultant cavity, or by extraction of the decayed tooth. This new MI approach accepts the model of dental decay can be visualised as a balance between the pathological factors promoting loss of calcium and phosphate from the dental hard tissues (demineralisation) and protective factors promoting the process whereby calcium and phosphate enter the dental hard tissues (remineralisation).
The concept of MI dentistry focuses on treating the causes of oral diseases instead of addressing its symptoms. The following new products are useful tools in the armoury to assist clinicians advocating minimally invasive dentistry.1
GC Tooth Mousse
Tooth Mousse is a water-based, sugar-free dental topical cream containing Recaldent CPP-ACP (caesin phosphopeptide-amorphous calcium phosphate). This complex of CPP-ACP is an ideal deliverer of calcium and phosphate ions to the oral cavity. When applied to the tooth surface, Recaldent restores the mineral balance within the dental hard tissues contributing to the reversal of non-cavitated tooth decay lesions and neutralising acid from bacteria found within plaque.2–5
Oral B Pro-Expert
Fluoride-containing toothpastes interfere with the process of tooth decay by a number of ways. It is accepted that the presence of fluoride in the plaque and saliva encourage remineralisation and ensures that the enamel crystals that are laid down are of improved quality.6–7
Oral B has overcome the innate instability issues of stannous fluoride and sodium hexametaphosphate and harnessed the long-recognised added benefits of stannous fluoride in its latest range of toothpastes.8–9
A low-water system in a silica-based dentifrice formulation significantly minimises the hydrolysis of the sodium hexametaphosphate and thus helps to maintain effective levels of polyphosphate activity and facilitatates the combining with stannous fluoride. Unlike traditional sodium fluoride formulation toothpastes, this low-water formulation has a proven effective antibacterial, anti-inflammatory, antiplaque, anti-halitosis, tooth-desensitising and whitening effect.10
Unfortunately, not all decay carious lesions are treatable with topical remineralising products. A “resin-infiltration” technique or “ultra-conservative” technique aims at occluding the highly porous structures of incipient enamel lesions through the use of low viscosity unfilled resins as sealants or bonding agents. Laboratory and in vivo studies have shown this technique to be a promising microinvasive approach to preserve demineralised enamel.11–12
In the advanced stages of tooth decay, intervention necessitates drilling of a tooth to remove the affected hard dental tissues. However, new materials are emerging on the dental market catering for the demands of MI technique. The first of such materials is Biodentine.
Biodentine is the first all-in-one bioactive13,14 and biocompatible15 dentine substitute, based on a unique active biosilicate technology. Released in 2010 after undergoing research in 300 patients over five years, Biodentine is seen as the future for tooth restorative materials.
Biodentine is an inorganic, non-metallic compound presented in a capsulated powder and liquid form. The powder phase consists of tricalcium silicate, calcium carbonate and zirconium dioxide and the liquid phase combines calcium chloride, water and a water reducing agent.16 Once mixed, the hydration reaction yields the final structure of set material composed of a hydrated calcium silicate gel matrix with crystals of calcium carbonate interposed between unreacted grains of cement.
Unlike amalgam (silver fillings) or composite-based silver fillings, which replace affected tooth tissue and may work to allow healing of the tooth pulp, Biodentine’s bioactivity helps to preserve pulp vitality in deep cavities by promoting generation of new dentine. Its use in a range of endodontic scenarios for the treatment of dental nerve conditions is promising.17
Management of halitosis
Halitosis is a common condition that may affect up to 30 per cent of the UK population, with most cases resulting from the action of anaerobic bacteria producing volatile sulphur compounds within the mouth.18 Pharmaceutical management involves the use of antimicrobial toothpastes and mouthwashes.
Cetylpyridinium chloride (CPC) is a cationic quaternary ammonium compound that has been used for over 60 years in oral hygiene products, including toothpastes, lozenges, throat, nasal and breath sprays. Research in oral bacteriology has conclusively shown that CPC found in mouthwashes has a broad antimicrobial spectrum with a rapid bactericidal effect on gram-positive pathogens and a fungicidal effect on yeasts. Clinically, this active ingredient reduces or inhibits bacterial gingivitis, biofilm, or plaque formation.19–21
On the other hand, Zytex is BreathRX’s (Philips) own blend of antibacterial and odour-neutralising ingredients. Essential oils have been used in dentistry since the 19th century for treating a range of dental ailments. Philips, using a non-alcohol delivery system, has harnessed the potential of the active ingredients of the essential oils to capitalise on their germicidal properties.22–24
Management of surgical procedures
Plasma rich in growth factors (PRGF-Endoret technology) is an endogenous therapeutic technology that is gaining popularity in the field of regenerative medicine due to its potential to stimulate and accelerate tissue healing and bone regeneration.25–26 Its uses in ulcer treatment, sports medicine, tissue engineering, and orthopedics are extensively researched. This technology delivered by BTI is revolutionising regenerative medical treatments in the field of dental implants.25
PRGF-Endoret autologous biotechnology is designed for development of different therapeutic formulations obtained from the patient designed for the in situ delivery of multiple cellular modulators and the formation of a fibrin scaffold for the stimulation and acceleration of tissue healing and regeneration. This technique derives a number of growth factors from a small sample of the patient’s blood by centrifugation. These factors are known to influence a series of biological processes that favour cellular migration, growth and morphogenesis. Research has also demonstrated that PRGF-Endoret also contains a pool of antimicrobial properties and strong bactericidal activity.27
Its clinical applications are broad because the technology can provide plasma rich growth factors in different formats (liquid, gel or fibrin membrane). For example, in liquid format, it can be used for wetting the dental implant surface to reduce the osseointegration time (time taken for direct structural and functional connection between the living bone and the titanium implant surface); it can also be used as a carrier for bone graft material to assist in bone regenerative procedures, and it can be used in the treatment of periodontal defects.28
Stem cell engineering
Tissue engineering of teeth requires the co-ordinated formation of correctly shaped crowns, roots and periodontal ligament.29 Research has suggested that erupted mature teeth have cell sources with the capacity to produce a tooth root.
However, the following problems in engineering new teeth have been
encountered. First, the success rate of production of tooth structure is low. Secondly, most regenerated teeth that have been produced so far exhibit disorganised heterogeneous morphology. Thirdly, the regenerated teeth do not reach the expected size of natural teeth.30
The current challenges faced in this technique are related to identifying an appropriate supporting scaffold for the engineered tissues to achieve the correct tooth morphology,31 and also managing the ethical and implantation issues of dental stem cells.32–33
This article has briefly highlighted a few of the modern approaches to how dentistry is being delivered and described a handful of products that have been manufactured in order to address the needs of the dental professional. Today’s evidence-based approach to the delivery of medical sciences has strengthened the need for a strong collaboration between scientists, healthcare professionals and pharmaceutical companies.
Citation: The Salvadore DOI: 10.1211/PJ.2014.11133536
Recommended from Pharmaceutical Press
Patient Care in Community Practice is a unique, practical guide for healthcare professionals or carers. Covers a range of non-medicinal products suitable for use at home.£22.00
Commonly known as the Orange Guide, this book is an essential reference for all involved in the manufacture or distribution of medicines in Europe.£82.00
Essential guidance for distributors of medicines for human use in Europe, compiled by the MHRA.£72.00
An essential guide on pharmacovigilance of medicinal products for human use. Practical advice for developing effective pharmacovigilance systems.£38.00
The Obesity Epidemic and its Management explains the causes, dangers and treatments of obesity.£38.00