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Tooth decay is caused by an infectious disease that initiates a caries disease process. The bacterial infection comes from the oral biofilm that covers the exposed hard surfaces of the teeth (enamel), which is commonly referred to as dental plaque. A mature biofilm is one that has not been disturbed for many months from dental clinic cleaning, brushing & flossing, or eating hard fibrous foods. Mature biofilms develop a microenvironment that can maintain acidic conditions at the enamel surface even though the saliva production is normal. When fed by sugars, bacteria in the biofilm rapidly produces more acid that demineralizes the enamel which weakens the protective covering of teeth and can lead to cavities. A deep cavity in the enamel cannot be repaired without surgery which is drilling and filling the cavity. Billions of people are affected by chronic caries or tooth decay. Because there is no accurate measurement that predicts if tooth decay will occur at a specific location, there are no conventional means for managing this chronic disease. For most other common chronic diseases such as atherosclerosis, high blood pressure, diabetes, and cancers, the highest risk patients are identified by measuring leading indicators of disease and managing these indicators so that surgery is held for the last resort of treatment. Currently, tooth decay does not have a leading indicator for site-specific tooth decay that can be easily measured and tracked over time.
The goals of Dr. Seibel's research are to provide the dentist, hygienist, and possibly the parents of children at highest risk of tooth decay the means to quantitatively measure the enamel health. This project identified and created such an early warning measurement which could be the foundation for future non-surgical management of tooth decay. By safely measuring the biofilm acid production that covers the enamel over time using small cameras, dentists can better predict the locations of future tooth decay. This gives the dentist time to manage the acid production for each individual patient, possibly enlisting the patient to treat these high-risk locations at home with a prescription and instructions. This new management process is much like a physician who gives her patient a prescription and instructions for healing an infection, such as a sinus or bladder infection. Thus, the surgery of drilling and filling teeth can be avoided in many cases. Interventions at an early stage would be medicinal treatments such as prescription-level fluoride applied to the highest risk location(s) in the mouth. For children, this may be a mobile phone app that the caregiver uses to locate the exact site and instructions on how to apply the treatments according to the schedule prescribed by the dentist.
To enable this new method of preventing tooth decay, the measurement of oral biofilm acidity was made optically after applying a low concentration of a fluorescence dye (fluorescein) that has been used in children for diagnosing diseases for many decades. Since the oral biofilm acidity was measured optically on the pH scale, we call this new method O-pH imaging (see Figure). In future studies with OpH imaging instruments, we believe that mapping oral biofilm pH at a dentist office can be a leading indicator of tooth decay, identifying locations that have the greatest acid production that are actively dissolving the protective enamel. Once the location that is high risk for a cavity is found, then medicinal treatments can be applied to help reverse the enamel demineralization process that would often lead to a cavity. We are currently working on prototype instruments that are designed for dental office use and possibly in the future for at-home use of monitoring self-applied medicinal treatments. We are hopeful that our children may be able to fight off caries disease with these new tools and keep their natural teeth intact for their entire lives.