Odontoblast differentiation: a response to environmental calcium?

The response of the dental pulp to calcium hydroxide has been well described but the process of pulpal repair leading to dentinal bridge formation appears complex and the mechanisms remain incompletely understood. Through the precise regulation of the free calcium ion in the cytosol, cells have been able to utilize anions such as phosphates for a wide range of activities such as energy production (oxidative phosphorylation). As anions are abundant in the cytosol, intracellular levels of calcium ions are kept low, several orders of magnitude less than that of the surrounding extracellular matrix. Consequently, cells are able to use calcium ions for the regulation of many cellular events. The binding of extracellular molecules such as cytokines, hormones or antibodies, with receptors on the plasma membrane may result in short- or long-term modifications to cellular metabolism, including the mechanisms of intracellular calcium homeostasis. Cell survival depends upon the ability to adapt to changes in the cell's micro-environment. Adaptation in turn results in altered cellular activity that may be interpreted as showing that the cell has become more or less specialised. In some instances this may include the resumption of mitotic activity. If the rate or magnitude of change exceeds a cell's adaptive capacity, the cell dies. Responses of cells to alterations in their environment are reviewed as they may provide an explanation for the success of calcium hydroxide in facilitating pulpal repair and the differentiation of odontoblasts.

A slow release calcium delivery system for the study of reparative dentine formation.

Several liquid, semi-solid and solid delivery systems were formulated and tested to devise a method of reproducibly administering accurate micro-doses of calcium into a 700 microns diameter cavity in a rat maxillary incisor tooth, in the absence of hydroxyl ions. Development of this delivery system was necessary to facilitate studies of the mechanisms of pulpal repair and odontoblast differentiation. The principal requirements for the delivery system were that it should be easily administered into a small pulp exposure in the rat incisor and that a greater than 1000-fold range in calcium ion concentrations could be incorporated and delivered for a period of 2-3 days, preferably in an acidic environment to minimize the effect of non-specific nucleation under alkaline conditions. Poly- (ethylene) glycol microspheres were found to be an ideal vehicle. Under the in vitro dissolution conditions used, complete release of all calcium salts occurred within 12-15 hours, except for the very water-insoluble calcium stearate. It was anticipated that the release of calcium ions would be significantly more prolonged in vivo because of the physical constraints of the prepared cavity as well as the restricted access to fluid flow.

In vitro characterization of poly(ethylene) glycol calcium citrate microspheres as a delivery system for the study of reparative dentinogenesis.

The characterization of poly(ethylene) glycol calcium citrate microspheres is described. The calcium content and content uniformity of microspheres, prepared at five concentrations ranging from 46.56 micrograms/g to 81.49 mg/g, were determined by spectroscopy. Under sink conditions first-order in vitro dissolution kinetics were observed. Granules containing approximately 80 mg Ca++/g PEG gave an in vitro calcium release over a 3-day period similar to that of a calcium hydroxide product, Pulpdent.

Serotonergic receptors as targets for pharmacotherapy.

Knowledge about neurotransmitters, their receptors and their physiological effects has exploded in the past 15-20 years. Serotonin exerts diverse effects as a neurotransmitter and in nonneural tissues. The molecular sites of serotonin binding, re-uptake and autoregulation have proven to be viable targets for pharmacological intervention in a variety of disorders.

Morphology of the mineralizing front and observations of reparative dentine following induction and inhibition of dentinogenesis in the rat incisor.

An extra oral approach was made to 26 pairs of Wistar rat incisors and a small bur used to expose the pulps which were then dressed with either calcium hydroxide paste (Pulpdent) zinc oxide-eugenol cement (Kalzinol) or a triamocinolone acetonide/tetracycline containing cement (Ledermix). Animals were sacrificed at 7 days, incisors removed, a window cut to the pulp opposite the site of exposure, soft tissues removed with 7% NaOCl for 30 minutes before teeth were dehydrated in graded concentrations of acetone and gold coated for examination under SEM. Calcium hydroxide produced rapid complete repair with a remarkably regular formation of calcospherites, except for a zone of relative inhibition perforated by nutrient canals at the periphery of each lesion. Both zinc oxide-eugenol and triamcinolone acetonide cements inhibited both bridging of the defect created by the exposure and dentine formation in the surrounding pulpal wall. Data was grouped according to the degree of hard tissue repair. The results were statistically significant (Chi-square p < or = 0.001). This method demonstrated qualitative and quantitative differences in the repair process resulting from chemical variations in the dressings applied.

Mucosal reactions to amalgam restorations.

Amalgam restorations have been implicated both in contact sensitivity reactions and in lichenoid reactions. This appears to be related principally to the mercury content, although other metals cannot be discounted. The cases of two patients are reported who showed features of lichenoid reactions of the oral mucosa, in addition to features of a contact hypersensitivity to mercury. The mucosal lesions resolved following replacement of the amalgams with non-metallic restorations. Consideration is given to the selection of materials and procedures currently available for treatment of these patients. This paper supports the view that sensitivity to heavy metals must be considered as a possible cause of erythematous and lichenoid reactions of the oral mucosa.

Impact-fracture energy of human premolar teeth.

The fracture strength of contralateral pairs of premolar teeth was determined by an in vitro method wherein impact loads of equal energy were applied to the medial aspects of the buccal cusps. Absorbed energy values quantified the fracture resistance of unprepared teeth and teeth restored with MOD amalgams, MOD amalgam overlays, MOD gold overlays, and full gold crowns. It was established that unprepared lower premolar teeth had a greater resistance to fracture than upper premolar teeth, and lower first premolar teeth were more resistant to fracture than the other premolar teeth; the fracture resistance of premolar teeth restored with MOD amalgams was significantly reduced compared with unprepared control teeth; MOD amalgam overlays in premolar teeth produced fracture resistances not significantly different from those for the unprepared controls; and restoration of premolar teeth with MOD gold overlays and full gold crowns enhanced fracture resistance to a level much greater than that of the unprepared control teeth.

Design of dental equipment for remote rural and field areas.

In the context of providing dental services, remote areas may be defined as those with overall low population densities; or isolated areas of low population density within more populous regions; or areas of high population density remote from dental services. The provision of equipment for remote areas is not simply a matter of extending the supply of conventional operatories to these regions. The particular needs of a region must be assessed first with equipment and instruments being selected to serve the skills of personnel who can be trained locally. The preventive-surface care operatory is the most basic yet most widely usable operatory. Staffed by auxiliary personnel it will facilitate communication, primary care procedures and the completion of non-invasive tasks. The design of operatories to a preferred work position will simplify the design of fixed installations and associated equipment and overall costs will be reduced. New educational methodologies will influence the design and manufacture of equipment more than in the past. For remote areas there are physical and practical limitations to equipment design but the preferred work position should not be compromised. If this is maintained the transfer of skills between different work places is simplified and mobilization of the operatory is facilitated.