Dentists See a Less-Grinding Future

The drill could become an art as experts predict 'bio-solutions' for a host of ills

FRIDAY, Dec. 28, 2001 (HealthDayNews) -- The dentist's office of a century ago resembled a torture chamber, compared to current methods. But patients of the future could soon be saying the very same thing about today's dental treatments, experts predict.

The mechanical and surgical repairs now used for a range of dental work, from battling tooth decay to rebuilding bone, will some day shift to what experts call "bio-solutions."

"These are simply biological solutions to biological problems," says Dr. Harold C. Slavkin, dean at the University of Southern California School of Dentistry.

Such molecular-based solutions will rely heavily on DNA, the genetic materials that are unique to each person, he adds.

Instead of fitting a decayed tooth with a metallic or composite crown, for instance, doctors predict they'll one day be able to regenerate a person's own teeth.

"A number of private companies, as well as academic units, are working on regenerating teeth, and we anticipate that in the not-too-distant future, we will have the ability to do so," says Slavkin, who addressed the bio-solutions topic at a recent meeting of the American Dental Association.

Regenerating teeth would be done with bio-engineering processes similar to those being looked at for the regeneration of other body parts, including the liver and even the heart.

"One process uses fetal cells, another uses stem cells from bone marrow in adults," explains Slavkin. "For instance, you'd isolate bone marrow from a person, put it in a dish, stimulate it to become the cells that make up teeth and produce a [tooth substance] that is identical to the patient from which you took the bone marrow sample."

One of the most crucial sources of stem cells arrives on the day a person is born -- in the umbilical cord.

"It's already standard in California that parents of newborns are asked if they would like to have a biopsy of the cord attaching the mother to the child to be put into a bank for later use if the child needs stem cells," Slavkin says.

"Feasibly in the future, it will be normal to have a little repository of stem cells in your name," he adds. "And as you grow older, they could be made into bone or cartilage or liver or tooth. And depending on your malady, they can be used and manipulated to address your need."

Some biological solutions that are already available, include genetic devices that can fight oral infections, Slavkin says.

"There are gene-based diagnostics for periodontal disease that have been approved by the FDA and are now in the marketplace," he says.

The products are marketed under a number of names, including Periostat.

"Basically, it's a biodegradable chip impregnated with a genetically engineered anti-microbial that's inserted into the pocket [in the gums] around the tooth that's infected," says Slavkin. "It reduces or eliminates oral infection."

In the future, DNA-based oral diagnoses could aid children who are born with genetic mutations that are not apparent at birth but show up during later stages of development.

For instance, a gene mutation responsible for a rare disease called Papillon-Levere syndrome (PLS), which causes an abnormal inflammatory response to oral infections, can result in children losing all their baby teeth by the age of four and all of their adult teeth by the age of 14.

By using a child's DNA sample for early diagnosis of this syndrome, dentists would be able to intervene with bio-solutions before the teeth are lost.

Other future techniques include materials that would release ingredients into the mouth to prevent decay.

"There's exciting research being done on what have been coined 'smart materials,' " says Dr. Alan A. Boghosian, an assistant clinical professor in the Division of Dental Surgery at Northwestern University Medical School.

Such materials would detect changes in the mouth that could increase decay -- when acidity drops because of dietary causes, for instance. The materials would then release certain ingredients into the mouth to fight that decay, Boghosian says.

In addition to the convenience of some bio-solutions, another great advantage would be using the body's own resources for both healing and disease prevention, Boghosian says.

"I think it's fair to say that trying to heal the human body by placing materials like porcelain and epoxy [in it] is nowhere near as desirable as trying to heal the body with its own natural systems," he adds.

"I look forward to a time in the future when dentists are less like repairmen and instead are applying certain growth factors and enzymes to allow the rebuilding of tooth with tooth," says Boghosian.

"It's still going to take a long time for us to get there, but the cellular level is where a lot of dental research is looking, and it's very exciting," he adds.

What to Do: Visit the American Dental Association's public information area for more on caring for your teeth. And you can read more about one of the treatments currently available, Periostat, at the American Academy of Periodontology.

SOURCES: Interviews with Harold C. Slavkin, D. D. S., dean, University of Southern California School of Dentistry; Alan A. Boghosian, D.D.S., assistant clinical professor, Division of Dental Surgery, Northwestern University Medical School, Evanston, Ill.; ADA press release
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