By: Jean Johnson for Dental1
From dental pulp and adult derived stem cell research to projects related to pain, trauma, wound healing, jaw necrosis, tissue engineering, and minimally invasive surgery, dentists have their sights set on pushing state-of-the-art dentistry to new heights.
The 2007 fiscal year began in October 2006, so Dental1 thought it an appropriate time to review each of these research areas – areas that Jay P. Malmquist, DMD of Portland, Oregon, president of the American Association of Oral and Maxillofacial Surgeons (AAOMS), listed in his U.S. House of Representatives Committee on Appropriations testimony as: “Support of Increased Funding for the National Institute of Dental and Craniofacial Research, Fiscal Year 2007.”.
|The National Institute of Dental and Craniofacial Research recommends the following home care:|
Brush twice daily with a soft brush with rounded bristles.
Use small circular motions and short back and forth motions, avoiding hard back and forth motions.
Use fluoride toothpaste.
Brush the tongue frequently.
Use plenty of floss – an 18-inch piece is ideal.
Floss with a sawing motion and curve the floss around each tooth on the front and back sides.
Floss from below the gum up to the top of the tooth.
Rinse after flossing.
The increase Malmquist requested on behalf of the AAOMS is 5.3 percent over 2006 and totals $410 million. In formulating his remarks, Malmquist drew on ideas from an AAOMS 2005 research summit that focused on ways oral and maxillofacial health care could potentially improve in the 21st century. Even though Congress only authorized part of the request, the six research areas identified by Malmquist reflect the cutting edge in dentistry.
Osteonecrosis of the Jaw from Bisphosphonates
Bisphosphonates are a family of powerful drugs used in treating both osteoporosis and certain types of cancer. Although these drugs are effective, one side effect can be what’s called osteonecrosis of the jaw. Osteonecrosis is a condition “which can leave patients with large areas of exposed bone in their jaws,” stated Malmquist. “The condition is extremely painful, infected, and difficult to treat.”
He adds that as the population ages, those with osteoporosis will increase and with that, so too will the use of bisphosphonates.
“Research is urgently needed to establish the incidence of osteonecrosis of the jaw in patients being treated with bisphosphonates,” he told the House Committee on Appropriations. “We must understand the mechanism of the disease in order to identify risk factors for osteonecrosis of the jaw, and to develop effective treatments.”
Dental Pulp and Adult Derived Stem Cell Research
It’s especially in the area of adult stem cell research that dentistry starts to look like bioengineering. Adult derived stem cells – an alternative to the use of embryonic stem cells – have everyone’s attention since, according to Malmquist, they “have the potential to differentiate into bone, muscle, cartilage, nerve, and vasculature under appropriate conditions.”
Further, Malmquist noted that dental pulp – in particular that from impacted third molars that are routinely extracted – are sources of adult stem cells along with the iliac crest or hip bone and adipose or fat cells. “Because oral and maxillofacial surgeons perform third molar extractions everyday, the potential exists to collect, isolate, and store adult derived stem cells from dental pulp for our patients’ future use.”
Research indicates that patients with Parkinson’s disease may especially benefit from adult stem cells derived from dental pulp.
Wound Healing: Avoiding “Long-term Functional Disturbances and Deformities”
A range of patients needing dental care have impaired abilities to heal after dental surgery or any dental procedure that causes bleeding. Diabetics – type 1 and type 2 – for example, are known to have reduced healing capability, as are smokers, cancer patients that have undergone radiation, and people with any disease in which the immune system is compromised.
Where this is particularly problematic in dentistry is when “excessive scar formation, delayed healing, or non-healing injuries to soft tissue and bone in the maxillofacial region lead to long-term functional disturbances and deformities,” Malmquist told the House of Representatives Committee on Appropriations.
What the AAOMS wants to see is an inter-disciplinary clinical investigation that would examine the process of wound healing at the cellular level. Researchers could then examine how the nexus of new blood vessels that help heal wounds are formed and what drugs might influence this process.
When experts study the pain mechanism and analgesics or pain killers, they tend to use what Malmquist calls the “the third molar extraction model.” Because dental pain can be exceptionally intense, it is what health care researchers tend to rely on in their investigations.
Malmquist argues that research in the area of oral and maxillofacial surgery will “improve diagnostics and develop effective therapies for the prevention or management of acute and chronic pain” in all areas of health care. He adds that clinical studies are necessary because pain itself is a complex dynamic.
Tissue Engineering: “Three-Dimensional Functional Tissue”
It has only been in the last 10 years that medicine and dentistry have made headway into the area of regenerative medicine. Nonetheless, the ability to in effect grow new body parts has everyone’s attention: dentists, physicians, and patients alike.
Malmquist told the House that “tissue engineering or regenerative medicine offers a new and exciting alternative for maxillofacial reconstruction.” He added that “research into tissue engineering could promote advances in wound healing…the goal is to develop three-dimensional functional tissue.”
Minimally Invasive Surgery
Anyone who has ever watched a dentist come toward their mouth with a scalpel will appreciate Malmquist’s thoughts on minimally invasive surgery. In particular, he maintains that the treatment of jaw fractures would benefit from new techniques.
“Three-dimensional imaging for navigation, endoscopy, miniaturization, nanotechnology, and robotics are promising areas for research and eventual application,” Malmquist said, indicating that he hopes the field of dentistry is able to investigate these cutting edge techniques.
Maxillofacial Trauma: From Returning Veterans to Civilians
“Advances in the treatment of maxillofacial trauma is an area of research that would provide significant value not only to our military personnel who experience a high rate of such injuries, particularly during current military conflicts, but also to the 18 to 23 percent of US non-fatal injuries that involve the maxillofacial area,” said Malmquist.
“Oral and maxillofacial trauma can be difficult to treat and may result in lasting disability.” Toward that end, longitudinal clinical trials that follow patients over time should be helpful.
Although not as much as was hoped for, the $386 hundred million in approved spending will surely enable dental experts to make some headway in a range of areas from minimally invasive surgery to regenerative medicine to adult derived stem cell research and beyond.