Nanotechnology’s untapped potential for prevention of oral disease: The next revolution in dentistry

Why hasn’t preventive care really changed all that much in the last 100 years? We know the prevention of dental caries starts with a core understanding of pH-based concepts, which drastically affects the oral biofilm’s capacity to dissolve tooth structure and the ability to direct the oral microenvironment back toward overall health. While many attempts have been made to alter the oral microenvironment, challenges still exist when addressing the fundamental issues pertaining to cariogenic biofilms and subsequent oral disease. While these problems are known to the scientific community, there has not yet been an oral hygiene system capable of both penetrating and successfully introducing neutralizing agents into the oral biofilm. With recent advances in nanotechnology, it is now possible to bypass and suppress oral biofilm mechanisms that were previously known to prevent the uptake of neutralizing agents and disturb the chain of cariogenic bacterial mechanisms, shifting toward oral disease.

The epidemic of oral disease

For nearly one hundred years, dentistry has followed the same oral hygiene regimen to prevent oral disease. While fluoride treatments and sealants have had a significant positive impact on oral health, there still exists a large unaddressed gap in the prevention of oral disease. This is shown by our current epidemic-level rate of decay, which approaches 50% in children and increases to 92% by adulthood.¹ Additionally, more than 80% of adults suffer from gingivitis and over 50% from periodontal disease.¹ This extreme level of disease not only places a strain on the time and financial status of individuals but can also lead to a concerning level of tooth loss. These disease paths are biofilm-based and largely preventable.

The challenge to oral homeostasis

To promote homeostasis, the following goals and endpoints must be considered:

Increasing salivary flow
Increasing the pH value of plaque fluid and saliva in a short period of time
Increasing calcium ion activity near the tooth surface (maintaining a degree of saturation)
Disrupting biofilm shifts toward pathogenesis
Producing a starved state for cariogenic bacteria (breaking apart, penetrating, and inducing biofilm dissolution of the exopolysaccharide (EPS) layer.
Utilizing a mechanism to deliver remineralizing agents into the oral biofilm

Many of the substances capable of penetrating the biofilm, such as chlorhexidine (CHX), may interfere with the remineralization process, thereby limiting their ability to be used with other agents.² In addition, fluoride and calcium have been shown to have very poor penetration into the oral biofilm when used alone.^3,4 These factors have further challenged the remineralization pathway to allow for optimal calcium ion activity near the tooth surface.

Nanotechnology—untapped potential for prevention

With the development of engineered nanotechnology, we can now penetrate deep into the oral biofilm while simultaneously stabilizing pH.^4,5 Elementa’s silver nanoparticles (AgNPs) have been specially designed and capped with a proprietary plant-based coating that mimics the biofilm’s outer EPS layer. This not only allows for easier entry into the biofilm but also improves their stability profile and biocompatibility.

Once inside the biofilm, AgNPs can exhibit neutralizing effects directly and indirectly by penetrating and opening channels into the oral biofilm for other beneficial agents to enter. Elementa’s products utilize multiple remineralization agents, such as xylitol and calcium, whose entry into oral biofilms is aided by the presence of AgNPs.⁴ This combination of minerals provides a strong buffering capacity against acid attacks and is designed to target deeper areas of the biofilm that favor cariogenic conditions.

These nanoparticles were also studied and shown to be noncytotoxic to oral tissues, thanks to their biocompatible coating and slow release of silver ions over time.⁶ AgNPs have been shown to be excellent antibacterial, biofilm-penetrating, alkalizing agents. In addition, these unique AgNPs have been studied for their remineralization potential of damaged enamel, showing promising results as an alternative to fluoride.⁷ In the past, formulations containing silver nanoparticles were unable to be combined with other agents due to their lack of stability in various media. Hence, AgNPs have not seen wide-scale use in combination therapy for oral care until recently.⁸ By using advanced engineering methods, AgNPs can now be combined with xylitol and neutralizing agents, such as calcium salts, to promote remineralization and stabilize oral pH levels. This has opened a new realm for exploratory prevention of oral disease.

Our search for a change began in cutting-edge nanotechnology that has proven to be extremely effective in many other medical fields, and what we discovered has changed the entire landscape of preventive oral products. Using AgNPs in oral care products has the potential to drastically increase the delivery of crucial ingredients, such as calcium and xylitol, directly to vulnerable tooth surfaces. Further, a carefully designed nano silver solution has the potential to quickly neutralize oral acids and reset the oral biofilm environment in a healthy way.

Author’s note: Visit this white paper—The cutting edge of dentistry: Utilizing nanotechnology for preventing dental caries and oral disease—that explains in further detail the content discussed in this article.

Editor’s note: This article first appeared in Through the Loupes newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe to Through the Loupes.

References

Dental caries (tooth decay). National Institute of Dental and Craniofacial Research. Updated July 2018. Accessed January 10, 2019. https://www.nidcr.nih.gov/research/data-statistics/dental-caries
Autio-Gold J. The role of chlorhexidine in caries prevention. Oper Dent. 2008;33(6):710-716. doi:10.2341/08-3
Tokura T, Robinson C, Watson P, et al. Effect of pH on fluoride penetration into natural human plaque. Pediatr Dent J. 2012;22(2):140-144.
Callister C, Callister M, Nolan M, Nolan R. Anti-caries potential of silver nanoparticles via modulation of free calcium activity within the plaque fluid of the oral biofilm: a pilot study. Dentistry. 2018;8:12. doi:10.4172/2161-1122.1000529
Thuptimdang P, Limpiyakorn T, Mcevoy J, Prüß BM, Khan E, Khan E. Effect of silver nanoparticles on Pseudomonas putida biofilms at different stages of maturity. J Hazard Mater. 2015;290:127-133. doi:10.1016/j.jhazmat.2015.02.073
Callister C, Callister M, Nolan M, Nolan R. Cytotoxicity of novel plant-based silver nanoparticles on fibroblasts for use in dental and medical applications. Japan J Res. 2020;1(1):1-5.
Callister C, Callister M, Nolan M, Nolan R. Remineralization potential of a novel silver nanoparticle rinse on severely demineralized enamel in-vitro: a 14-day trial. J Nanomed Nanotech. 2020;11(2):542. doi:10.35248/2157-7439.20.10.542
Beyer K. Influence of capping agents on silver nanoparticle (AgNPS) toxicity to nitrifying bacteria. San Diego: San Diego University; 2012.

Ben Lewis is the vice president of marketing for Elementa, Revolutionary Oral Care. The company was founded to share its breakthroughs in the area of oral disease with the world. For years, Lewis has participated in many seminars, meetings, and expos centering around the preventive oral care space.