Unconventional Dental Treatment

tentchoirAI and Robotics

Nov 15, 2013 (3 years and 8 months ago)

128 views

Unconventional Dental Treatment

1

Unconventional Dental
Treatment


Presented By


Riham Mohamed Aly

Unconventional Dental Treatment

2

Unconventional Dental Treatment


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

3

So What Are The Alternatives?

1
-

Unconventional medicine


2
-

Biological Dentistry


3
-

Vaccines


4
-

Tooth Regeneration

Unconventional Dental Treatment

4

1
-

Unconventional Medicine


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

5

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

6

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.

Classification Of UD

Unconventional Dental Treatment

7


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

8

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

9

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

10

ADA positions and statements:

(Policy Statement On UD)


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

11

So What Are The Alternatives?

1
-

Unconventional medicine


2
-

Biological Dentistry


3
-

Vaccines


4
-

Tooth Regeneration

Unconventional Dental Treatment

12


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
:


Neural

Therapy


Cold

Laser


Mouth

Balancing

and

Nutrition

2
-

Holistic Or Biological Dentistry

Unconventional Dental Treatment

13


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
:


Neural

Therapy


Cold

Laser


Mouth

Balancing

and

Nutrition

Neural Therapy


It claims that when
inflammation or infection is
present in the mouth,there is
usally blockage in the body's
normal energy flow, since every
cell possess its own specified
frequency range


Injection of LA around the tooth
in question to remove the energy
blockage will resolve the problem

2
-

Holistic Or Biological Dentistry

Unconventional Dental Treatment

14


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
:


Neural

Therapy


Cold

Laser


Mouth

Balancing

and

Nutrition

Cold Laser


It is an alternative form of
accupunture for patient who
refuse needles.


It is supposed to kill bacteria &
aid in wound healing and treat
TMJ dysfunction.


The power output and the light
spectrum used doesn’t cause any
thermal damage thus called
“cold “

2
-

Holistic Or Biological Dentistry

Unconventional Dental Treatment

15

2
-
Holistic Or Biological Dentistry (cont.)


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

16

Amalgam/Mercury Toxicity
Controversy :


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

17

So What Are The Alternatives?

1
-

Unconventional medicine


2
-

Biological Dentistry


3
-

Vaccines


4
-

Tooth Regeneration

Unconventional Dental Treatment

18

3
-

Vaccines


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

19

3
-

Vaccines (cont.)


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

20




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

21

Criteria to be considered:


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

22

Evidence that the anti
-
caries
vaccine will be effective:


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

23

What will be the microbial target?


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

24

DNA vaccines


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

25

Which component of the immune
system will be targeted ?



There is a difference in opinions regarding
whether IgG or IgA is responsible for the
defense mechanism.



IgA 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.



IgG 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

26

How and When it is introduced ?


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

27

Active and Passive Immunization


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

28

So What Are The Alternatives?

1
-

Unconventional medicine


2
-

Biological Dentistry


3
-

Vaccines


4
-

Tooth Regeneration

Unconventional Dental Treatment

29

4
-

Whole tooth regeneration


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

30

Tooth Regeneration &Biomimetic


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

31

Tooth regeneration and
Biomimetics (cont.)


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

32

Important information that needed
to be discovered


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

33

Three key element for Regenerative
Dentistry


A) Inductive Morphogenetic signals


(morphogenes )



B ) Stem Cells




C ) Extra cellular matrix scaffold

Unconventional Dental Treatment

34

Three key element for Regenerative
Dentistry

Unconventional Dental Treatment

35

A ) Inductive Morphogenes


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

36

A) Inductive Morphogenes (cont.)


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

37

B) Stem Cells


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

38

B) Stem Cells (cont.)


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

39

B) Stem Cells (cont.)


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

40

C) Extracellular Matrix


or Biomimetic scaffold


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

41

C) Extracellular Matrix


or Biomimetic scaffold


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

42


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.

Regeneration of dentin pulp
complex

Unconventional Dental Treatment

43

Regeneration of the dentin pulp
complex


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

44

Conclusions


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

45






Thank You