Prof Nigel Pitts, Dental Innovation and Translation Centre, Kings College London Dental Institute in conversation with ENN, discusses the issue of caries “ the biggest dental problem, and his innovative remineralization technology
Do you consider caries to be the greatest dental concern ?
Dental caries in children (according to Lancer Series on global burden of diseases) was ranked at number 10 in the list; severe periodontal disease stood at number 6, while tooth loss rated at number 23. Dental caries is certainly the biggest burden for the global population today. It is a preventable disease (caries) that is still causing an unacceptable burden.
What causes caries, and what can be done to prevent it ?
Caries is a multi-factorial issue. Sugar is certainly one of the key causes behind caries. It begins with a tooth surface which is susceptible to caries, and a biofilm which is ending up with low pH. Earlier, we used to have a focus on individual microorganisms, but today the focus is very much on the whole ecology of the biofilm. There are certain types of biofilm where when it meets sugar, it gets unacceptably low pH, which demineralizes the tooth. Yet, there are other biofilms which are much more compatible with health and they could be made up in many different ways, and theyre very much health promoting. So, its a chain of interactions combined with biofilm, combined with tooth and combined with sugar. Its a combo interaction of these three agents over time to do damage.
People should be advised to try to maintain a high level of oral hygiene. The focus should be on cleaner mouths, if not plaque-free. It varies from patient to patient. What matters is clean mouth, limited or controlled sugar and carbohydrates in your diet and using preventive products where you need to. Again, the level of oral care varies from individual to individual. The key agent that we can consider is fluoride and its different forms. It can be fluoride in toothpaste or fluoride in mouth rinse. There are even efforts to supplement the use of fluoride and build on the additional benefits. Fluoride continues to be the global standard in oral hygiene.
What is the role and relation of sugar in promoting caries ?
Sugar come in a variety of forms and they are all key agents in promoting caries. Sugar, like salt, is hidden in a wide variety of food products. Besides, we need to look at tooth susceptibility and biofilm as well. Impact of sugar on health and more precisely oral health has been a debate since long. There are only rejoinders to this debate. This will allow caries prevention to get into wider places of debate and policies about prevention that will help address the problem of obesity and general healthcare as well.. The latest reports and the WHO papers on sugar have given a new twist and stimulus to new groups to appear and the old groups to renew their efforts. Its a very important area and the lobby has been there for long.
You are the Chairman of the global ACFF (Alliance for Cavity- Free Future), what is this alliance about and how important is it ?
The Alliance for a Cavity-Free Future, a non-profitable charitable organization, is a worldwide group of experts who have joined hands together to promote integrated clinical and public health action in order to stop caries initiation and progression, and to move towards a Cavity-Free Future for all age groups.
Worldwide, 60-90 percent of school children and nearly 100 percent adults have dental cavities. In fact, dental caries ( which includes all stages of tooth decay) is the most common, yet preventable chronic disease on the planet. When dental caries occurs, hard tissue in the tooth is damaged by acids that naturally exist in our mouth and help break down foods, which results in tooth decay. Early dental caries can be prevented and controlled if the multiple causative factors, namely a susceptible tooth surface, the presence of cariogenic and acid producing bacteria in dental plaque biofilm, and the exposure to ingested carbo-hydrated and sugars are reduced.
When was ACFF initiated and its global strength ?
Since it establishment in 2010, the Alliance has increased its global presence to 15 chapters around the world, including Australia, Brazil, Central America, Central Eastern Europe, China, Colombia, India, Malaysia, Mexico, Pan-Europe, Philippines, Russia, South Africa, Turkey and Venezuela, with additional chapters to follow. A sampling of acativities include providing tools via a local ACFF website, securing commitment from dental school deans to integrate caries prevention and management into school curriculum and promoting community based education and prevention programs to families and communities.
What does the future hold for fillings for minor cavities ?
Researchers at Kings College London are developing a procedure that uses low frequency electrical currents to help teeth self heal cavities without drilling. Drillings may become a thing of the past. Precisely called electrically accelerated and enhanced remineralization, will put an end to fillings for early-stage lesions and moderate tooth decay. Possibly, it could lead to more treatments for more advanced decay.
Alliance for a Cavity-Free Future Declaration
Global collaborative action is needed to challenge global leaders and other stakeholders “ including country and community leaders, health and dental health professionals, public policy and education communities and the public “ to learn the importance of caries as a disease continuum and to participate in action toward the delivery of comprehensive caries prevention and management that can positively influence the continuing problem of caries. This action should:
Ensure that primary prevention with appropriate fluoride strategies are in place.
Promote the preventive control of initial caries lesions through education to change human behavior and the use of appropriate, evidencebased technologies.We call upon interested organizations and individuals to join the Alliance for a Cavity-Free Future and make a collective commitment to take action and elevate the importance of caries prevention and management as a global health issue.
When to expect this technology to reach the dental clinic ?
This technology is expected to make it to the dentists offices within three years. By the time a dentist examines a cavity- chances are high that he is seeing a tooth that has already lost minerals in the enamel and is on the way to decay.
There is a possibility of replacing these minerals with ones found in saliva or fluoride through a natural remineralization process. Researchers have been trying to figure out and fix how to enhance that process by making it faster and allowing it to work more deeply in the tooth.
Remineralizationhas been talked about since 1980s ?
Yes, we in the dental research field have known about remineralization for some time but its been hard to achieve a viable way that will remineralize established, large lesions in depth. The eureka moment came dentists started focusing on preparing the tooth by removing barriers to the remineralization process, including saliva and tissue. The next step involves the use of electrical currents to help drive minerals into the tooth.
We place a healing hand piece on the surface of the tooth for the duration of the relatively quick procedure. It emits an imperceptible electric current that drives minerals back into the tooth. It will be a a painless process and cost as much as traditional filling.
Will it lead to a greater turnover of patients ?
Yes, the technology might be close to meeting the growing demand for a popular, pain-free, effective solutions to cavities that will encourage people from coming back to the dentists office for other serious problems such as gum disease.
The procedure thats involved in cutting a cavity and giving an injection is in some ways really uncomfortable. For some patients its a real phobia. When patients are more relaxed, theyll come for monitoring.