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.