Plaster which sticks inside the mouth will revolutionize treatment of oral conditions

A plaster which sticks to the inside of your mouth is revolutionising the treatment of painful recurring ulcers.
Scientists from the University of Sheffield's School of Clinical Dentistry, working in close collaboration with Dermtreat A/S from Copenhagen, have developed a unique patch using special polymers which are able to stick to moist surfaces.
The patch successfully administers steroids directly to oral ulcers or lesions whilst also creating a protective barrier around the affected area, accelerating the healing process.
The novel plaster is a breakthrough therapy for the treatment of mucosal conditions such as oral lichen planus (OLP) and recurrent aphthous stomatitis (RAS), which are diseases that cause painful lesions and affect 1-2 per cent of the population.
Until now, ulcers and lesions inside the mouth have been treated using either creams or mouthwashes, which are used in the whole mouth rather than targeting the specific area, making them less effective. However, the biodegradable Rivelin® patch, has a long adhesion time and a high flexibility which conforms to the surface inside the mouth.
Dr Craig Murdoch, Reader in Oral Bioscience School of Clinical Dentistry and lead author of the research, said: "Chronic inflammatory conditions such as OLP and RAS, which cause erosive and painful oral lesions, have a considerable impact on quality of life.
"Current treatments consist of using steroids in the form of mouthwashes, creams or ointments, but these are often ineffective due to inadequate drug contact times with the lesion.
"The patch acts like a plaster inside your mouth, which means it is very effective at directly targeting the specific area as well as forming a protective barrier.
"Patients who have trialled the patch found it to be very comfortable to wear and they were really pleased with the length of adhesion which makes it particularly effective and efficient."
Jens Hansen, Chief Executive Officer at Dermtreat A/S, added: "Collaboration with the University of Sheffield has undoubtedly accelerated the translation of our intellectual property towards clinical use. Our company are very confident that we will soon gain regulatory approval for the first adhesive drug delivery technology to address pressing clinical needs in oral medicine.
"We look forward to continuing this collaboration, which will be increasingly directed at finding new clinical applications for muco-adhesive patches."
Dermtreat A/S was recently awarded $17.7 million from the venture capital firm Sofinnova. The funding will take the patches into phase two clinical trials, which will run at several sites in both the US and the UK - including at the Charles Clifford Dental Hospital in Sheffield. In addition, Dermtreat are funding further research at the Dental School to develop the next generation of patches that contain other useful drugs.

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The findings of the research are published in the journal Biomaterials.
To view the full paper, please visit: https://doi.org/10.1016/j.biomaterials.2018.06.009

Gum disease may be a key initiator of rheumatoid arthritis related autoimmunity

The results of a study presented at the Annual European Congress of Rheumatology (EULAR 2018) demonstrates increased levels of gum disease, and disease-causing bacteria, in individuals at risk of rheumatoid arthritis (RA).1
"It has been shown that RA-associated antibodies, such as anti-citrullinated protein antibodies, are present well before any evidence of joint disease. This suggests they originate from a site outside of the joints," said Dr Kulveer Mankia of Leeds Institute of Rheumatic and Muscoskeletal Medicine and the Leeds Biomedical Research Centre (study author). "Our study is the first to describe clinical periodontal disease and the relative abundance of periodontal bacteria in these at-risk individuals. Our results support the hypothesis that local inflammation at mucosal surfaces, such as the gums in this case, may provide the primary trigger for the systemic autoimmunity seen in RA."
Rheumatoid arthritis is a chronic inflammatory disease that affects a person's joints, causing pain and disability. It can also affect internal organs. Rheumatoid arthritis is more common in older people, but there is also a high prevalence in young adults, adolescents and even children, and it affects women more frequently than men.
The prevalence of gum disease is increased in patients with RA and could be a key initiator of RA-related autoimmunity. This is because autoimmunity in RA is characterised by an antibody response to citrullinated proteins and the oral bacterium Porphyromonas gingivalis (Pg) is the only human pathogen known to express an enzyme that can generate citrullinated proteins.2
"We welcome these data in presenting concepts that may enhance clinical understanding of the key initiators of rheumatoid arthritis," said Professor Robert Landewé, Chairperson of the Scientific Programme Committee, EULAR. "This is an essential step towards the ultimate goal of disease prevention."
In results from the study, dentists diagnosed clinical gum disease in significantly more at-risk individuals than in healthy controls (73% vs. 38%, p=0.02). In addition, the percentage of sites with clinical attachment level (CAL) ?2mm, pocket depth (PD) ?4mm, bleeding on probing (BOP), periodontal disease (PDD), and active periodontal disease (PDD+BOP), were all significantly greater in the at-risk individuals compared to controls (p<0 .05="" active="" and="" at-risk="" compared="" controls.1="" in="" individuals="" more="" non-smokers="" p="" pdd="" prevalent="" to="" were="">DNA was isolated from the subgingival plaque, next to the gums, of each participant and used to measure the levels of three types of bacteria, Pg, Aggregatibacter actinomycetemcomitans (Aa) and Filifactor Alocis. Results showed that there was increased abundance of both Pg and Aa in at-risk individuals. However, in at-risk individuals, only Pg was significantly increased at healthy dental sites and was associated with the overall extent of gum disease (p<0 .001="" p="">The study included 48 at-risk individuals (positive test for anti-citrullinated protein antibodies, musculoskeletal symptoms but no clinical synovitis), 26 patients with RA and 32 healthy controls. The three groups were balanced for age, gender and smoking. At-risk individuals underwent ultrasound assessment to assess for subclinical synovitis; only two (4%) were found to have ultrasound synovitis. Dentists examined six sites per tooth in each participant and a clinical consensus was agreed in each by three dentists.1

Water fluoridation confirmed to prevent dental decay in US children and adolescents

The fluoridation of America's drinking water was among the great public health achievements of the twentieth century but there is a scarcity of studies from the last three decades investigating the impact of water fluoridation on dental health in the U.S. population. A recent study "Water fluoridation and dental caries in U.S. children and adolescents," published in the Journal of Dental Research, evaluated associations between the availability of community water fluoridation and dental caries (decay) experience in U.S. child and adolescent populations.

In this large study, county-level estimates of the percentage of population with community water fluoridation from the Centers for Disease Control and Prevention 's Water Fluoridation Reporting System were merged with dental examination data from 10 years of National Health and Nutrition Examination Surveys (1999-2004 and 2011-2014).

The analysis showed that U.S. children and adolescents with greater access to fluoridated drinking water were less likely to experience dental caries. Counties in which over 75% of the population had access to community water fluoridation saw a 30% reduction in dental caries experience in the primary dentition, and a 12% reduction in dental caries experience in the permanent dentition, compared to counties in which less than 75% had access to community water fluoridation.

The findings are consistent with evidence from the last half-century showing that community water fluoridation continues to provide a substantial dental health benefit for U.S. children and adolescents. The current study boosts the evidence by showing that the benefit is most pronounced early in life, in the primary teeth of 2-8 year olds.

"This study confirms previously reported findings and provides additional evidence in support of water fluoridation as a core public health intervention promoting oral health," said Maria Ryan, President of the American Association for Dental Research. "AADR supports community water fluoridation as a safe and effective, evidence-based intervention for the prevention of dental caries and this report further adds to that evidence base."

Periodontal cell sheet technique promotes bone and ligament formation on dental implant

Mary Ann Liebert, Inc./Genetic Engineering News

IMAGE: Tissue Engineering brings together scientific and medical experts in the fields of biomedical engineering, material science, molecular and cellular biology, and genetic engineering. view more 

Credit: Mary Ann Liebert, Inc., publishers

New Rochelle, NY, June 11, 2018--Researchers used periodontal ligament (PDL)-derived stem cells to create a cell sheet, attached it to a titanium implant, and transplanted it into the mandibular bone of a dog, demonstrating the formation of a periodontal-like structure containing both cementum- and PDL-like tissue. The study, which shows the feasibility of combining a regenerative cell sheet with a titanium dental implant, is published in Tissue Engineering, Part A, peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available free on the Tissue Engineering website until July 11, 2018.
The article entitled "In Vivo Periodontium Formation Around Titanium Implants Using Periodontal Ligament Cell Sheet," describes the creation of a stem cell-containing cell sheet derived from a PDL. In the human mouth, the PDL helps protect against infection and the absorption of bone caused by mechanical stress. Coauthors Isao Ishikawa, DDS, PhD, Tokyo Women's Medical University (TWMU) and colleagues from TWMU and Tokyo Medical and Dental University, Japan and Chulalongkorn University, Bangkok, Thailand documented the formation of cementum, a thin bony layer that attaches the teeth to the jaw.
"This truly innovative work combines traditional dental implants with stem cell sheet technology, thus creating a particularly relevant solution to a widespread problem in dental health care," says Tissue Engineering Co-Editor-in-Chief John P. Fisher, PhD, Fischell Family Distinguished Professor & Department Chair, and Director of the NIH Center for Engineering Complex Tissues at the University of Maryland, College Park.

Scientists develop material that could regenerate dental enamel

Queen Mary University of London

IMAGE: Close-up of the enamel-like material. view more 

Credit: Alvaro Mata

Researchers at Queen Mary University of London have developed a new way to grow mineralised materials which could regenerate hard tissues such as dental enamel and bone.
Enamel, located on the outer part of our teeth, is the hardest tissue in the body and enables our teeth to function for a large part of our lifetime despite biting forces, exposure to acidic foods and drinks and extreme temperatures. This remarkable performance results from its highly organised structure.
However, unlike other tissues of the body, enamel cannot regenerate once it is lost, which can lead to pain and tooth loss. These problems affect more than 50 per cent of the world's population and so finding ways to recreate enamel has long been a major need in dentistry.
The study, published in Nature Communications, shows that this new approach can create materials with remarkable precision and order that look and behave like dental enamel.
The materials could be used for a wide variety of dental complications such as the prevention and treatment of tooth decay or tooth sensitivity - also known as dentin hypersensitivity.
Dr Sherif Elsharkawy, a dentist and first author of the study from Queen Mary's School of Engineering and Materials Science, said: "This is exciting because the simplicity and versatility of the mineralisation platform opens up opportunities to treat and regenerate dental tissues. For example, we could develop acid resistant bandages that can infiltrate, mineralise, and shield exposed dentinal tubules of human teeth for the treatment of dentin hypersensitivity."
The mechanism that has been developed is based on a specific protein material that is able to trigger and guide the growth of apatite nanocrystals at multiple scales - similarly to how these crystals grow when dental enamel develops in our body. This structural organisation is critical for the outstanding physical properties exhibited by natural dental enamel.
Lead author Professor Alvaro Mata, from Queen Mary's School of Engineering and Materials Science, said: "A major goal in materials science is to learn from nature to develop useful materials based on the precise control of molecular building-blocks. The key discovery has been the possibility to exploit disordered proteins to control and guide the process of mineralisation at multiple scales. Through this, we have developed a technique to easily grow synthetic materials that emulate such hierarchically organised architecture over large areas and with the capacity to tune their properties."
Enabling control of the mineralisation process opens the possibility to create materials with properties that mimic different hard tissues beyond enamel such as bone and dentin. As such, the work has the potential to be used in a variety of applications in regenerative medicine. In addition, the study also provides insights into the role of protein disorder in human physiology and pathology.