Is it possible to restore tooth enamel and how to do it?

Structure of tooth enamel

Tooth enamel is the main protector of teeth and completely covers their crown part. The average thickness of the tissue is about two millimeters: in the chewing area the layer is slightly thinner, and on the sides of the teeth, on the contrary, it is thicker. The color of tooth enamel depends on its density and the quality of dentin, as well as on some individual characteristics of the body, but this type of tissue is essentially transparent.

The composition of tooth enamel includes, for the most part, inorganic substances (more than 95%). The percentage of water content is very small (approximately 3%): this is partly why such high strength is achieved. Inorganic materials primarily refer to hydroxyapatite crystals (a mineral containing fluorine, magnesium, carbon and other elements). The presence of hydroxyapatite crystals also explains the fact that the enamel is vulnerable to the effects of an acidic environment, i.e. The consumption of foods that increase the acidity of saliva is contraindicated. This is especially true for calcium ions, on which the integrity and density of the enamel largely depends.

Types of damage to tooth enamel before teething

Dysplasia

A number of disorders, which is characterized by a number of signs: gray spots, thinning of the enamel or the absence of fragments of the enamel layer. In the vast majority of cases, dysplasia is associated with genetic abnormalities, metabolic disorders and bone diseases. When teething, teeth may be irregular in shape (triangular, pear-shaped, etc.).

To treat erosion of tooth enamel, multivitamins, sodium fluoride, and electrophoresis are prescribed. In case of extensive lesions, artistic restoration and prosthetics are used to restore aesthetics. To avoid complications, dental enamel dysplasia in children requires immediate treatment.

Hypoplasia

With hypoplasia, atrophy of tooth tissue or its complete absence is observed at the intrauterine level. Usually the disease is associated with a mineral imbalance. Hypoplasia is expressed by a change in color (to gray or brown), the appearance of spots, thinning of the enamel and even its complete absence (aplasia).

When treating thinning enamel, medications are prescribed to restore mineral balance (calcium gluconate solution, etc.), as well as a complex of vitamins. In case of aesthetic problems, whitening can be performed, and in severe cases, the tooth is covered with a crown or veneer.

Hyperplasia

Excess dental tissue, the appearance of which is also caused by an imbalance of mineral balance (usually due to hormonal imbalances in parents or blood diseases). On the surface of the tooth, so-called enamel drops are formed - islands of brown or reddish color. For more complex anomalies, hypertrophied areas can be filled with dentin or pulp.

Treatment of hyperplasia includes polishing teeth with a drill, applications and rinsing with fluoride and calcium solutions in combination with taking medications that normalize the mineral composition and eliminate the root cause of the deviation.

Fluorosis

When dental fluorosis occurs, spots, grooves, pits, or streaks form on the surface of the enamel. The disease is caused by an excess of fluoride in the body and often occurs in children.

Remineralization of enamel, grinding of teeth, and normalization of the amount of fluoride in the body are indicated. In difficult cases - orthopedic treatment and artistic restoration.

Changes in the structure and violation of the integrity of the enamel can be caused by a number of genetic abnormalities and hereditary diseases. That is why it is important to establish the root cause so that the best treatment can be prescribed if tooth enamel is damaged or atrophied.

The recipe is ready

That's all, in short, what is needed to create teeth. Thus, the recipe for creating a tooth looks something like this:

• Stem cells - assorted
• Scaffold is a natural product
• Growth factors - to taste

Regenerative medicine technologies are progressing incredibly quickly. And now, probably, the most basic provisions for dental tissue engineering have already been developed. They all stem from our knowledge of the cellular and molecular basis of tooth development. We understand that the best result in tooth bioengineering can be achieved only in the presence of two types of cells, and not one: these are both epithelial cells and mesenchymal cells (where would we be without them?) [28]. However, you cannot build a tooth on cells alone. Thus, the role of growth factors and extracellular matrix cannot be excluded here. Fortunately, science does not stand still, and new provisions are being actively developed. Perhaps, in the near future, the treasury of knowledge called “dental tissue engineering” will be replenished with another equally valuable “coin”.

But, despite all the promising potential of tissue engineering in dentistry, there are still problems to be solved related to the conduct of clinical trials, the innervation and blood supply of the bioengineered tooth, its ligamentous apparatus, the timing of its eruption, as well as the choice of a pool of stem cells and technology for working with them , and a number of other equally pressing tasks [10], [29].

As for the most basic thing, namely stem cells: in the experiments performed (it is worth noting that almost all of them were carried out on mice), they mainly used embryonic stem cells. But in the clinic their use is sharply limited, including by law. Therefore, only postnatal stem cells remain (not counting iPSCs, where things are also not calm), and here we face the following snag: unlike mice, humans lack a niche of dental stem cells, which is why our teeth do not have the ability to constantly grow. Those MSCs that are suitable for use cannot be obtained without damaging the tooth, or even more so if the tooth was previously treated endodontically, that is, with pulp removal. Those to which access is open do not have odontogenic competence, for example, gingival MSCs. This is just one of the dilemmas that remain to be resolved (Fig. 9).

Figure 9. The fight for healthy teeth for humanity.

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Damage to enamel after tooth formation

This section describes in detail the causes of diseases and destruction of tooth enamel that are not caused by genetic factors and congenital diseases at the stage of formation of tooth germs.

How to strengthen tooth enamel?

The level of modern dentistry makes it possible to successfully eliminate tooth enamel defects through therapeutic and orthopedic techniques. In case of serious problems, it is necessary to use crowns, composite or ceramic veneers, but the best option is to preserve healthy and natural teeth. Today, many manufacturers offer various products that help avoid problems such as softening, erosion and thinning of tooth enamel.

Strengthening tooth enamel in adults

• Regular intake of vitamins B6 and B12, group D, as well as drugs that promote the absorption of calcium and fluoride.
• Therapeutic and prophylactic gels and toothpastes. Cleaning tooth enamel with non-abrasive products that contain calcium, fluoride and other components to strengthen the enamel.
• Mineralization of tooth enamel and regular preventive teeth cleaning. If you have naturally weak tooth enamel, these procedures are necessary to prevent the development of caries and other diseases. Tooth enamel whitening can be carried out only after consultation with your doctor, who will confirm the absence of contraindications.
• Prevention at home. Massage the gums, eat vegetables, fruits and legumes.

Remember that tooth enamel does not deteriorate in one day, but over many years, so the sooner you start caring for it, the longer you will maintain an attractive smile.

Strengthening tooth enamel in children

• Fluoridation. Application of special fluoride-containing varnishes to the surface of tooth enamel. After teething, the procedure is recommended to be carried out twice a year.
• The use of preventive mouth guards and application gels containing calcium, fluoride and vitamins.
• Fissure sealing to protect chewing teeth from caries.

Prevention and protection of tooth enamel in children will help to avoid serious problems in the future, so taking care of teeth should begin from the moment they erupt.

Competition "bio/mol/text"-2017

This work was published in the “Free Topic” category of the “bio/mol/text” competition 2017.

The general sponsor of the competition is: the largest supplier of equipment, reagents and consumables for biological research and production.

The sponsor of the audience award and partner of the “Biomedicine Today and Tomorrow” nomination was.

"Book" sponsor of the competition - "Alpina Non-Fiction"

...They say evil has no face. Indeed, no feelings were reflected on his face. There was not a glimmer of sympathy on him, but the pain was simply unbearable. Can't he see the horror in my eyes and the panic on my face? He calmly, one might say, carried out his dirty work professionally, and at the end he politely said: “Rinse your mouth, please...”

This is how Dan Andrews describes a visit to the dentist in his short story “Wretched.” Indeed, since childhood, we have been in incredible awe of such specialists as dentists. Parents do everything they can to force their children to at least go to the doctor’s office, trying not to think about what awaits them next. And sometimes an adult’s soul sinks at the sight of numerous tools. Sometimes just the sight of a dental clinic is enough to do this.

As a result, the state of the oral cavity and dental hard tissues around the world does not inspire hope for a future without caries. Despite advances in dental treatment, tooth loss remains one of the most significant problems. Thus, according to WHO, the main causes of tooth loss are caries and periodontitis. Complete tooth loss is particularly common among older people. Globally, approximately 30% of people aged 65–74 years are missing teeth due to inflammatory periodontal diseases and pathology of dental hard tissues [1].

Therefore, it is not surprising that the state of the oral cavity of the population not only in Russia, but also in the world represents a serious problem, offering opportunities both for study and, more importantly, for the search for new treatment methods. One of them was tissue engineering , an interdisciplinary branch whose goal is to create biological substitutes that restore and maintain the functions of a tissue or organ. The fairly high efficiency of tissue engineering methods and their potential have attracted the attention of many scientists. This also contributes to their unfading popularity in various fields of medicine to this day.