Orthodontics inspires new approach to help bones mend themselves

Young babies and newborn mice can naturally heal damage to the bones that form the top of the skull, but this ability is lost in adults. In a new study published in Proceedings of the National Academy of Sciences, University of Pittsburgh researchers developed a novel approach that promoted bone regeneration in mice without implantation of bone tissue or biomaterials. The technique uses a device similar to an orthodontic wire used to realign teeth to carefully stretch the skull along its sutures, activating skeletal stem cells that reside in these wiggly seams. In adult mice, the technique repaired damage to the skull that otherwise would not have healed on its own.

In mice, which have very similar skull development to humans, the researchers used a so-called bone distraction device to carefully apply a controlled pulling force to the calvarial bones, strong enough to slightly widen the sutures but not enough to cause a fracture. Using single-cell RNA sequencing and live-imaging microscopy, they found that the number of stem cells in the expanded sutures of these animals quadrupled. As a result, mice treated with the device regenerated bone to heal a large defect in the skull.

The researchers are investigating how their findings could be used to inform novel therapies in people, not just to heal skull injuries but also fractures in long bones such as the femur. Bone distraction devices are already used to treat certain conditions such as a birth defect called craniosynostosis, in which the calvarial bones fuse too early, so expanding this technique to promote bone regeneration could be a future focus of clinical trials.

From: https://www.sciencedaily.com/releases/2023/04/230414113455.htm

A growing connection among diabetes, oral health, and dementia highlights the importance of dental care and diabetes management as we age. Having both diabetes and tooth loss contributes to worse cognitive function and faster cognitive decline in older adults, according to the study, ‘Diabetes, Edentulism, and Cognitive Decline: A 12-Year Prospective Analysis’, published in a special issue of the Journal of Dental Research.

While both diabetes and missing teeth are risk factors for dementia, little research has focused on the effects of having both conditions in the course of cognitive decline. To address this gap, Prof. Bei Wu, the study’s lead author, and her colleagues turned to the University of Michigan’s Health and Retirement Study, analysing 12 years of data (2006-2018) from the longitudinal study in order to observe cognitive changes over time.

The researchers included 9,948 older adults who were grouped by age in their analysis. The study included measures of memory and cognitive function, assessed every two years, along with questions about tooth loss, diabetes, and other health and demographic factors.

They found that older adults aged 65-84 with both diabetes and complete tooth loss had worse cognitive function than their counterparts without either condition. Over time, older adults aged 65-74 with diabetes alone experienced accelerated cognitive decline, and those aged 65-84 without any teeth also experienced accelerated cognitive decline, but older adults aged 65-74 with both diabetes and complete tooth loss had the fastest rate of cognitive decline.

For older adults with both poor oral health and diabetes, the researchers stress the importance of regular dental visits, adherence to diabetes treatment and self-care to control blood sugar levels, and cognitive screenings in primary care settings.

From: https://uk.dental-tribune.com/news/diabetes-and-toothlessness-together-worsen-cognitive-decline/

Many infectious diseases, such as Covid-19, are known to spread through aerosols and droplets suspended in the air. Therefore, it is necessary to fully understand the hazards of aerosols and droplets presented during dental treatment.
Using a dental air turbine and a mannequin, researchers at Tohoku University in Japan recreated the droplets and aerosols that occur during dental procedures. Key tools in the experiment were the high-sensitivity camera and high-intensity LED light source, which allowed for high-quality images of droplet spreading during the simulated procedure, which was previously difficult to do in real-time without dye.
Extra-oral suction (EOS) and intra-oral suction (IOS) were used to determine how well these devices work. Using these techniques, the researchers reduced droplet and aerosol spread within the air by 97.8% when both EOS and IOS were used, and a 92.1% using IOS alone.
The researchers found that a patient’s treatment can alter the directionality or spread of the droplets. For example, it was discovered that treatments for cavities on the anterior teeth are most likely to be associated with droplet spreading. Furthermore, the correct placement of oral suction devices is important, with the most effective positioning of the EOS device found to be about 10cm away from the patient’s mouth at a 0^o angle.
While this study confirmed the effectiveness of IOS and EOS at reducing droplets in the air during dental treatment, some limitations will require future testing. The mannequin could not simulate breathing, which may produce differing results. Further investigations using a patient model will be required to clarify the efficacy of these oral suction devices.
The results of this study were published in the Journal of Prosthodontic Research.

From: https://uk.dental-tribune.com/news/led-imaging-visually-confirms-oral-suction-device-efficacy-in-droplet-and-aerosol-reduction/

A global taskforce of academic experts has concluded that teledentistry has the ability to give millions more people around the world regular access to dental services.

Brought together by the Oral Health Foundation and Unilever, the group found that teledentistry has the potential to remove or reduce many of the major barriers associated with access to oral healthcare, specifically in developing and emerging countries. The panel determined that teledentistry can be an effective method for education, dental referrals, early detection of disease, treatment planning and compliance, and treatment viability. Teledentistry was deemed especially useful where the access to dental professionals is limited or not evenly spread over a country or region. It was also seen as a cost-saving measure for the patient and the dental clinic.

While investigating the main barriers to dental access, a low number of qualified dentists in developing nations was listed as a substantial problem. The analysis revealed significant opportunities for evidence-based oral health advice that can be delivered by implementing specific teledentistry models.

To tackle many of the barriers associated with dental access, Pepsodent has launched a teledentistry initiative across Indonesia and Vietnam. The project aims to reduce oral diseases among the most vulnerable people by making dental access more inclusive, readily available, and financially affordable. The group investigated the major global barriers to accessing dental care and reviewed the most recent publications on teledentistry projects. The panel then suggested possible outcomes, as well as practical implications of delivering teledentistry services around the world.

From: https://www.dentalhealth.org/news/taskforce-backs-the-benefits-of-teledentistry-to-improve-global-oral-care-outcomes

Exposing the immune system to citrullinated bacterial proteins is seen as a trigger for rheumatoid arthritis (RA). The anti-citrullinated protein antibodies (ACPAs) seen in many RA patients, which serve as a diagnostic marker, may have their origin in periodontal disease, researchers said.

Traces of bacteria associated with periodontal disease have been found in samples collected from rheumatoid arthritis patients.

The research group wrote in Science Translational Medicine: “Our findings indicate that damage of the oral mucosal barrier mediated by [periodontal disease] results in repeated, spontaneous translocation of citrullinated oral bacteria to the blood, which trigger innate and adaptive immune responses in RA associated with systemic disease flares”.

Researchers conducted a series of studies in several patient cohorts. Their findings confirmed that oral bacterial components (especially from Streptococcus species) entered the circulation at higher rates in the RA patients with periodontal disease compared to those without. The researchers also determined that during RA clinical exacerbations, expression spiked for genes associated with inflammatory monocyte responses in synovial tissue, but only in the patients with periodontal disease. Tracing the connection between the two conditions could help develop therapies for rheumatoid arthritis, while the approach that led to the study could prove fruitful in other disease contexts, such as cancer.

From: https://uk.dental-tribune.com/news/periodontal-disease-is-more-common-in-patients-with-rheumatoid-arthritis-according-to-new-study/

Researchers from Tohoku University’s Graduate School of Dentistry in Japan have discovered that softer gums hinder the development of gingiva fibroblasts — the cells that help produce the fibres that hold our teeth in place.

The tissue area that surrounds our teeth is known as the gingiva, and healthy teeth will nestle firmly into the gums thanks to the many gingival fibres that connect the tooth to the gingiva. It was discovered that gingiva stiffness influences the properties of gingival fibroblasts, which in turn affect whether inflammation is likely to occur and make gingival fibres difficult to form.

Associate Prof. Masahiro Yamada, along with his colleague Prof. Hiroshi Egusa, also from the Tohoku University’s Graduate School of Dentistry, created an artificial culture environment that simulated soft or hard gingiva and cultured human gingival fibroblasts on them. They discovered that hard gingiva-simulated stiffness activated an intracellular anti-inflammatory system in the gingival fibroblasts that prevented inflammation. Yet, soft gingiva-simulated stiffness suppressed the fibroblastic anti-inflammatory system. This increased the likelihood of inflammation and resulted in less collagen synthesis.

Associate Prof. Masahiro Yamada explains: “Our research is the first to demonstrate the biological mechanisms at play in regard to a patient’s gingival properties. The results are expected to accelerate the development of advanced biomaterials to control local inflammation or microdevices that simulate the microenvironment of inflammatory conditions”.

Their findings were published in the journal Scientific Reports on January 24, 2023.

From: https://www.sciencedaily.com/releases/2023/03/230310103440.htm

Researchers in Japan have found that the patients who are most likely to schedule a dental check-up are those who understand the benefit of check-ups in preventing disease and those who have existing positive oral health behaviours.

Evaluations included an oral examination and questionnaire that went beyond enquiring about oral health status and behaviours to asking about participants’ willingness to improve their overall health according to a particular health belief model, as well as their response to a risk aversion scenario.

The results indicated that when the participants were more likely to see themselves facing a risk of a negative health outcome in addition to seeing a clear benefit, they were more motivated to engage in preventive health actions. The researchers also found a significant positive association between willingness to have a dental check-up and the oral health behaviours of flossing or using interdental brushes.

The team suggested that the correlation was due to self-efficacy, a concept in the health model that deals with confidence that one can take the actions necessary for producing a certain outcome. It would be expected that risk aversion would drive people to adopt healthy behaviours; however, risk aversion was not demonstrated to be a factor in scheduling dental check-ups.

The study, titled ‘The impact of oral health behaviours, health belief model, and absolute risk aversion on the willingness of Japanese university students to undergo regular dental check-ups: A cross-sectional study’, was published in the International Journal of Environmental Research and Public Health.

From: https://www.dental-tribune.com/news/study-evaluates-health-beliefs-and-oral-habits-on-students-willingness-to-get-dental-check-ups/

There is increasing demand for clear aligner therapy (CAT) for mild to moderate malocclusion in adults. However, there is a lack of information on the motivations of adults seeking CAT, as well as their socio-demographic information and oral health status across countries. Researchers in Germany compared adult patients in Austria, Germany, Italy, Poland and Spain. They found that adult patients who are dissatisfied with their appearance and who generally have good oral health are more likely to seek CAT.

The main demographic findings were that adults seeking CAT were mostly younger than 35 and female. Patients in Italy and Germany were the youngest, the majority being in the 18- to 35-year-old age group. The highest proportion of men seeking CAT was in Italy and the lowest in Poland.

When it came to motivation, crowding was the top reason, but this was more frequent among the Spanish and Italian patients, and tooth spacing was a more common reason among the German and Austrian patients. Men more often gave spacing as their primary motive, and women more frequently indicated crowding.

The researchers noted that the patients had an overall better quality of oral health than the general population, likely because they are more concerned about their oral health as evidenced by seeking CAT. As the treatment is mostly an out-of-pocket expense, the researchers also noted that the socioeconomic status of the patients likely differs from that of the general population.

The records from CAT provider, DrSmile were compiled from over 500 associated practitioners across Europe. The resulting sample size was 15,015 patients. The study, titled ‘Who seeks clear aligner therapy? A European cross-national real-world data analysis’, was published in Life.

From: https://www.dental-tribune.com/news/study-establishes-patient-motivations-for-seeking-clear-aligner-therapy-across-five-european-countries/

In a study of nearly 3,000 schoolchildren, silver diamine fluoride (SDF) – a liquid that is brushed onto teeth to prevent cavities or keep them from worsening – was as effective against cavities as dental sealants, the standard of care. A single dose of either topical treatment given in primary schools prevented roughly 80% of cavities and kept 50% of cavities from worsening.

The findings, published in JAMA Network Open, offer an efficient and cost-effective approach to improving children’s oral health through school-based care. Dental caries (cavities) is the most common chronic disease in children, and those from low-income families are twice as likely to have cavities as those from higher-income families. Without proper and timely intervention, cavities can lead to severe infections, reduce children’s quality of life, and are associated with lower student academic performance and school attendance.

CariedAway is a randomised trial comparing the effectiveness of two cavity-prevention techniques: a ‘simple’ treatment using SDF and fluoride varnish; and, a ‘complex’ treatment using traditional glass ionomer sealants and fluoride varnish. Both are non-invasive and applied to the surface of teeth to prevent and arrest cavities in children, but for the same time and cost, providers can treat more children with the simpler SDF therapy.

The study included 2,998 children in kindergarten through to third grade at 47 New York City schools. The schools were randomised to receive either the simple or complex treatment. Two years later, researchers returned to each school for follow-up.

They found that both the simple and complex treatments were successful: just one cavity prevention treatment prevented more than 80% of cavities (81% for SDF and 82% for sealants) and stopped half of cavities from progressing (56% for SDF and 46% for sealants).

From: https://www.sciencedaily.com/releases/2023/02/230210145811.htm

A study from researchers at the University of Sheffield has sought to examine how the general public perceives the push for sustainability within the dental profession and to better understand what compromises will be accepted in the name of environmentally friendly dentistry.

Data regarding the participants’ views about sustainable dentistry, as well as demographic data and information about the participants’ overall oral health, was collected between August 2020 and February 2021. In total, 344 adults responded to the survey.

Overall, the researchers found that participants responded quite positively to sustainable dentistry and were “moderately willing to compromise time and convenience”. They were somewhat likely to agree to pay more and receive potentially less durable dental treatment if it meant that the treatment would be more environmentally conscious. Respondents were least likely to accept compromises regarding the appearance of their teeth or their oral health status, whereas those having better self-rated oral health were more likely to view sustainable dentistry in a positive light.

Older respondents were less likely to want to compromise their time and convenience than younger respondents, whereas women displayed more positive attitudes regarding sustainable dentistry than men did.

In their discussion, the authors recognised a number of limitations regarding their study, including the relative homogeneity of respondents, the lack of measuring household income or socio-economic status and the focus on participants’ willingness to make compromises rather than on their actual behaviour.

The study titled ‘Exploring attitudes towards more sustainable dentistry among adults living in the UK’, was published online in the British Dental Journal.

From: https://uk.dental-tribune.com/news/study-examines-public-perceptions-regarding-sustainable-dentistry/