Teeth are subject to many problems, most of which are caused by bacteria. Unfortunately, the state of medical technology when it comes to control of harmful bacteria in the mouth lags far behind the policing of bacterial populations in other scenarios and locations. It is fairly well understood how bacteria cause gum disease and cavities, meaning which species are responsible and which mechanisms are important, but so far no lasting strategy for removing unwanted oral bacteria or blocking their activities has made it out of the laboratory and into the clinic. Getting rid of bacteria in the mouth is easy, but ensuring that only certain specific types are removed, and keeping them removed past a few hours or days, has turned out to be far more challenging.
Nonetheless, some promising avenues have emerged, even though they remain somewhere in the process of development. This is the case for methods of regrowth of tooth enamel; I recall discussing a few specific approaches more than a decade ago, and yet here we are, still reliant upon drills and fillings. Some groups have pursued cell and tissue engineering approaches to growing enamel. Back in 2010, a group demonstrated regeneration of cavities in mice by delivering a peptide known to encourage bone formation, and that worked on enamel as well. That attempt was conceptually similar to far more recent research noted here, in which a different peptide is used to spur enamel deposition.
Researchers have designed a product that uses proteins to rebuild tooth enamel and treat dental cavities. This can - in theory - rebuild teeth and cure cavities without today's costly and uncomfortable treatments. "Remineralization guided by peptides is a healthy alternative to current dental health care. Peptide-enabled formulations will be simple and would be implemented in over-the-counter or clinical products."
Bacteria metabolize sugar and other fermentable carbohydrates in oral environments and acid, as a by-product, will demineralize the dental enamel. Although tooth decay is relatively harmless in its earliest stages, once the cavity progresses through the tooth's enamel, serious health concerns arise. Good oral hygiene remains the best prevention. Taking inspiration from the body's own natural tooth-forming proteins, researchers came up with a way to repair the tooth enamel. They accomplished this by capturing the essence of amelogenin - a protein crucial to forming the hard crown enamel - to design amelogenin-derived peptides that biomineralize and are the key active ingredient in the new technology.
"These peptides are proven to bind onto tooth surfaces and recruit calcium and phosphate ions." The peptide-enabled technology allows the deposition of 10 to 50 micrometers of new enamel on the teeth after each use. Once fully developed, the technology can be used in toothpaste, gels, solutions and composites as a safe alternative to existing dental procedures and treatments. The technology would enable people to rebuild and strengthen tooth enamel on a daily basis as part of a preventive dental care routine.
White spot lesions (WSL) and incipient caries on enamel surfaces are the earliest clinical outcomes for demineralization and caries. If left untreated, the caries can progress and may cause complex restorative procedures or even tooth extraction which destroys soft and hard tissue architecture as a consequence of connective tissue and bone loss. Current clinical practices are insufficient in treating dental caries.
A long-standing practical challenge associated with demineralization related to dental diseases is incorporating a functional mineral microlayer which is fully integrated into the molecular structure of the tooth in repairing damaged enamel. This study demonstrates that small peptide domains derived from native protein amelogenin can be utilized to construct a mineral layer on damaged human enamel in vitro. Six groups were prepared to carry out remineralization on artificially created lesions on enamel: (1) no treatment, (2) Ca2+ and PO43- only, (3) 1100 ppm fluoride (F), (4) 20 000 ppm F, (5) 1100 ppm F and peptide, and (6) peptide alone. While the 1100 ppm F sample (indicative of common F content of toothpaste for homecare) did not deliver F to the thinly deposited mineral layer, high F test sample (indicative of clinical varnish treatment) formed mainly CaF2 nanoparticles on the surface.
Fluoride, however, was deposited in the presence of the peptide, which also formed a thin mineral layer which was partially crystallized as fluorapatite. Among the test groups, only the peptide-alone sample resulted in remineralization of fairly thick (10 μm) dense mineralized layer containing HAp mineral, resembling the structure of the healthy enamel. The newly formed mineralized layer exhibited integration with the underlying enamel as evident by cross-sectional imaging. The peptide-guided remineralization approach sets the foundation for future development of biomimetic products and treatments for dental health care.