Identification of an appropriate material capable of enamel remineralization to fill a cavity after the removal of dental tissue is a new field of dental research. Elucidation of the associated factors involved in enamel defects remain in question including the mechanisms of enamel hypoplasia as well as improvement needed in our current treatment models. The purpose of this thesis is to evaluate the factors associated with enamel defects, to understand the mechanism by which they evolve, as well as look into a new method of treatment called, fluorapatite cement. This new treatment has shown promising affects to improve our current treatment to restore enamel defects, however, to find the best treatment we must understand the foundations of enamel and how defects arise.
Enamel is the strongest tissue in the body because it must maintain resistance to factors such as bacterial adhesion, acidity, and temperature. Enamel defects can present as white spots, discoloration, or deep fissures in the enamel due to a disturbance that occurred during tooth oogenesis. Enamel hypoplasia provides favorable conditions for the early development of caries and the retention of plaque, which can progress and reach deep into the enamel and the dentin and cause sensitivity. Our current treatment is efficient and has been used for decades, however, requires the surrounding health enamel to be removed. This is a disadvantage and has encouraged scientists to continue researching for an effective way to remineralize enamel and avoid the loss of healthy enamel.
Diseases such as coeliac disease have an influence on the formation of enamel that lead to defects. A recent study investigated if dentists can play a role in early diagnosis of diseases including coeliac disease by examining patients for enamel defects. The study discovered that there was not a significant difference in oral evaluations to determine upon early diagnosis, however, they did conclude that there was pattern in the types of defects that were found in coeliac patients. Specifically, grade I and II defects were found on the anterior teeth of coeliac patients, therefore, the study still recommends seeing the dentist for oral exams as well as supports further study.
To understand the mechanism of how defects arise, scientists studied first permanent molars in children during their first three years of life with factors including, institutionalization, gender, medications, and diseases. Studies showed that females have a two-fold risk for enamel defects over males and institutionalized children have a three-to-four-fold risk of enamel defects.
To improve our current treatment and avoid loss of healthy enamel and a costly procedure, scientists are looking into the use of hydroxyapatite (HA), a natural occurring mineral in our body, to create a possible new synthetic enamel called fluorapatite (FA) cement. Research analyzed fluorapatite cement compared to natural enamel and found that FA cement has a stronger resistance to acidity with a weight loss of 0.75% wt% compared to enamel with 1.2% and greater resistance to bacterial adhesion than natural enamel by three times. FA cement was also found to have more stability and higher cellular activity than hydroxyapatite. As for safety for dental application, FA cement and HA were placed in simulated body fluid to test for cytotoxicity levels, and none were present. Therefore, FA cement has a promising approach to restore enamel defects effectively and conveniently.
Further research is recommended to understand the association of females and institutionalized children with enamel defects versus all children in a larger study group. The current reported results from fluorapatite cement are very promising. This cement can allow an inexpensive and more efficient method of treatment due to its abilities to remineralize enamel that even stronger than natural enamel. The recent hydroxyapatite and fluoride toothpaste products show the growing research that is being put into this idea of creating a synthetic enamel with our current mineral hydroxyapatite. This thesis supports the idea that FA cement has the potential as an alternative to current treatment for enamel defects and hopefully will be ready to undergo a clinical trial in the near future.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/47467 |
| Date | 03 November 2023 |
| Creators | Tarian, Stephanie |
| Contributors | Davies, Theresa A. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
| Rights | Attribution 4.0 International, http://creativecommons.org/licenses/by/4.0/ |
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