Health and Disease

Diabetes and Periodontal Disease

Diabetes and periodontal disease – two different diseases which, at first glance, do not seem to have any similarity. Yet a significant proportion of the population has one of the two diseases and is unaware of the evidence that suggests that there is a causal link between them.

Approximately 8% of the US population has been diagnosed with diabetes, which is characterised by uncontrolled blood sugar levels. At the same time, around 47.2% of adults aged 30 and older have had some sort of periodontal disease. Periodontal disease is a complex condition characterised by many features, primarily gingivitis and periodontitis. Gingivitis is caused by the inflammation of the periodontal tissue (gums). Further inflammation may result in periodontitis, eventually leads to periodontal pocketing, the destruction of tooth-supporting structures and bone loss, and even further complications like tooth loss. 

Gingivitis is the primary stage before it progresses and worsens to periodontitis or periodontal disease. The transition from gingivitis to periodontitis involves the spreading of the inflammatory front to deeper areas in connective tissue. The reason why this occurs is not completely known but the presence of bacteria or by-products like lipopolysaccharides may induce this. Furthermore, patients with periodontal disease also have a higher prevalence of Helicobacter pylori (H.pylori). There are cases where gingivitis does not transform into periodontitis as bacterial accumulation is necessary for the disease to worsen in a specific region. More research is being conducted on this disease due to its increasing prevalence in affluent countries. Findings show that while an increased sugar intake in conjunction with poor oral habits contribute to the occurance of these oral diseases, a multitude of other factors such as income, education and smoking also play a part. 

So, what is the relationship of this oral disease with diabetes? There is clear evidence to suggest that the causal relationship is both ways. Periodontal disease is seen to be more severe in diabetic patients and there is also poorer glucose level control in patients with periodontal disease. That said, while research is still on-going, the effects of periodontitis and its treatment on diabetes metabolic control are not clearly known.

People with type 2 diabetes are around 3 times more likely to develop dental problems than people who don’t. Those who are type 1 diabetic are also more at risk. Diabetes has multiple links to different oral diseases, even apart from periodontal disease. Salivary and taste dysfunction, oral bacteria, fungal infection and traumatic ulcers are just some of them. One causal link to be suggested between diabetes and periodontal disease is through advanced glycosylation end products (AGEs). Studies show that chronic hyperglycaemia (excess sugar in blood plasma) produces AGEs that bind to specific receptors on different cells like fibroblasts, endothelial cells and macrophages. These cells are turned into hyperreactive cells that produce inflammatory cytokines. Furthermore, diabetes increases the glucose concentration of saliva and this, in combination with harmful bacteria, causes plaque formation which leads to cavities. The formation of plaque near the gum line hardens into a deposit called tartar which is the first step to causing gum disease. Patients with diabetes also receive multiple medications and some may hinder the ability of the mouth to make saliva, increasing the risk of dental cavities.

There are also clear causal links showing that periodontal disease has a part in causing diabetes. Gum disease and infection is shown to increase blood sugar levels too. This not only increases the risk of diabetes but has associations with other complications like heart disease. Further research has presented that periodontitis is associated with elevations in HbA1c in non-diabetic individuals. HbA1c is a vital indicator of whether an individual has diabetes as it measures average blood sugar levels over the previous 2/3 months. However, the mechanism of why the HbA1c levels are higher remains unknown.

Overall, there is clear evidence to present that there is a causal relationship between diabetes and periodontal disease in both directions. A clear-cut causation of periodontitis leading to diabetes is not as strong as the research showing the opposite route of how diabetes increases the risk of periodontal disease but it is still clear that patients with periodontal disease will experience worse effects if they are also diabetic. As a large majority of the population is still unaware of such a causal relationship, it is important to present to patients that any improvement in their diabetic control will control the effects of periodontal disease and vice versa for diabetes. 

Arya Bhatt, Youth Medical Journal 2022


Image: Llambés, F., Arias-Herrera, S. and Caffesse, R. (2015). Relationship between diabetes and periodontal infection. [online] National Library of Medicine. Available at:

Llambés, F., Arias-Herrera, S. and Caffesse, R. (2015). Relationship between diabetes and periodontal infection. [online] National Library of Medicine. Available at:

National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Diabetes, Gum Disease, & Other Dental Problems | NIDDK. [online] Available at:

Diabetes UK. (n.d.). Diabetes and gum disease. [online] Available at:

Health and Disease

Arya Bhatt: Water Fluoridation

Water fluoridation is the adjustment of fluoride ions within the public water supply. Through extensive research, water fluoridation has been evidenced to improve the oral health of the wider population, especially in areas of lower deprivation where levels of oral health are seen to be much worse. This article will look into how water fluoridation is implemented into society and evaluate whether the use of such systems is justified. Despite the initial benefits which may be visible in public water fluoridation, there are some potential drawbacks which a government would consider.

Water fluoridation does not change the taste, appearance or smell of drinking water and is completed by adding either sodium fluoride, fluorosilicic acid, or sodium fluorosilicate. These compounds are used to stimulate remineralisation of enamel on teeth. Sodium fluoride is more expensive than the other two and was the first compound used. Fluorosilicic acid is the most commonly used additive in the United States for fluoridation but the costs are high in transportation as it exists in liquid form. Sodium fluorosilicate is the sodium salt of fluorosilicic acid and is easier to ship than fluorosilicic acid. Even though water fluoridation schemes are utilised, natural sources of fluoride include seafood, potatoes, coffee and many fruits such as apples and peaches.

The first artificial water fluoridation for caries control was first introduced in 1945 in the US and a large fall in caries prevalence occurred. This not only presented the prospect of water mineralisation but also allowed for more dental products to include fluoride such as toothpaste and mouthwash. An increase in overall fluoride intake stimulates mineralisation of teeth while reducing likelihood of demineralising. The most appealing prospect of water fluoridation is that the general public does not have to take an active role in ensuring they receive fluoridated water. The American Dental Association stated that fluoride in water reduced tooth decay by around 20 to 40%. Whilst the World Health Organisation recommends a maximum level of 1.5mg/L of fluoride, areas of the UK with access to water fluoridation have around 1mg/L. Within the UK one large motivator for an increase in water fluoridation schemes is the large number of children with tooth decay. Within 2019 to 2020, 37,000 children were admitted to hospital to extract decayed teeth and the overall estimated annual cost to the National Health Service (NHS) for all tooth extractions in children is £50 million. A cultural change in children having sugary food and drink has exacerbated this effect but alongside dental education, water fluoridation will improve the oral health of certain communities.

Images reference:

a)       Regional difference in the prevalence of tooth decay in 5-year-old children in 2019

b)      Areas of fluoridation schemes and naturally occurring

These inequalities in oral health are driven by socio-economic status and deprived groups are more likely to have worse dental health. This is the reason why hospital-based tooth extractions are also more common in these areas of low socio-economic status. As seen in the comparisons of images (a) and (b), the areas in which water fluoridation schemes are put in place are closely linked to areas with high decay experience. Some areas are also fortunate to have naturally occurring fluoride due to the environment.

Despite these systems for improvement in oral health taking place, there are some limitations to water fluoridation. During childhood, a large exposure to high concentrations of fluoride during childhood can cause dental fluorosis, which results in white streaks and spots on the enamel which affects the aesthetic of the teeth. However, this is mainly for very young children. Skeletal fluorosis is another side effect of high concentrations of fluoride which leads to pain and damage to bones. This may lead to impaired joint mobility and an increased risk of fractures. There has been some research taken place to suggest neurological damage to unborn babies.

Even though some side effects to high fluoride exposure are visible, the overall oral health of the population would be improved with controlled amounts of fluoride which not only reduces NHS costs but avoids the need for patients, especially children, to undergo surgery for extractions due to decay. These fluoridation schemes being introduced alongside dental education on diet and care will improve the oral health of a population.

References: Water fluoridation – Wikipedia. [online] Available at:,and%20is%20the%20reference%20standard.

Arbor Oaks Dental. 2021. Natural Sources of Fluoride. [online] Available at:

Aoun, A., Darwiche, F., Hayek, S. and Doumit, J., 2018. The Fluoride Debate: The Pros and Cons of Fluoridation. [online] National Library of Medicine. Available at:

UK Parliament. 2021. Water fluoridation and dental health. [online] Available at: 2018. Why do we have fluoride in our water?.[online] Available at:

Biomedical Research Health and Disease

Is stem cell treatment a viable option in restorative dentistry?

By: Arya Bhatt

Stem cells have been at the forefront of scientific research and have been an invaluable tool in the scientific field due to their fantastic properties. Their ability to divide over and over again to produce many new cells whilst specialising in the different types of cells the body requires has enabled researchers to explore this phenomenon and implement it into a wider variety of scenarios, most of which deal with the treatment of diseases which were thought to be incurable. Now with stem cell research expanding and its uses becoming more prevalent, one growing use of it is within restorative dentistry. Restorative dentistry involves the study, diagnosis and integrated management of diseases of the oral cavity, the teeth and supporting structures.1 One of the many treatment options within this field explores the uses of stem cells to provide optimal patient care.  Within the stem cell field, there are many different types of stem cells and each has its different sources and implementations. There are totipotent stem cells that can differentiate into any of the 220 cell types of the body, including the placental cells. Embryonic cells in their early stages are totipotent. Pluripotent stem cells give rise to all cell types except placental cells and multipotent stem cells develop into a certain limited number of cell types.2 Stem cells can be further categorised depending on their source. Eg. Adult stem cells, also called tissue-specific stem cells, can differentiate into different cell types for the specific tissue they are extracted from.3 For example, stem cells in the bone marrow generate different blood cells but not other cells of the body. Mesenchymal stem cells, also called MSC, refers to cells isolated from the stroma which is the connective tissue surrounding tissues and organs. These were first discovered in the bone marrow and have capabilities to make bone, cartilage and fat cells.3 These stem cells may be a useful tool in restorative dentistry. Furthermore, induced pluripotent stem cells (iPS) are stem cells that have been engineered in the lab to behave like pluripotent stem cells.3 Extensive research is still taking place and what different properties these cells have and how these can be implemented. Stem cells have these fantastic uses to generate new cells but are these viable in restorative dentistry?

First, a clear idea of what restorative dentistry revolves around has to be explored so an idea can be formed on how stem cell treatment can be used to treat patients who want to receive restorative treatment. Restorative dentistry refers to a wide variety of treatments including crowns, bridges, fillings, veneers and more. These treatments provide functional restoration as well as cosmetic satisfaction for the patient. The important factors to consider are whether the treatments can be replaced by stem cell treatment and where the stem cells are obtained from.

For example, using stem cell treatment to provide treatment to patients for veneers wouldn’t be theoretically advantageous due to the nature of a veneer. A patient’s veneers have to be strong, thin, durable as well as aesthetic and there is no requirement to explore whether stem cells could be used for veneers as the current veneers available are highly successful and suitable for patients. There is no real requirement for stem cell research or other research to take place to explore other alternatives to veneers. On the other hand, a restorative procedure such as an implant may have better alternatives if stem cell research has developed and a method to ‘regrow’ cells is a viable option with benefits.

Another factor to consider involves the source of the stem cells. For instance, mesenchymal stem cells can be sourced from multiple parts of the body, like the bone marrow. Accessing stem cells is one of the limitations and ethical debates regarding the use but new sources are being discovered. For example, stem cells, whether they are utilised in restorative dentistry or not can be extracted from the dental pulp. Stem cells can also be extracted from human exfoliated deciduous teeth (SHED). These stem cells are from the same source as dental pulp stem cells but from primary teeth which will fall out by around the age of 12.  One of the benefits of these cells is that they have been seen to have the capability to produce dentine and induce bone formation.4 Other stem cells that can be obtained from the oral cavity include periodontal ligament stem cells, root apical papilla stem cells and dental follicle stem cells. Obtaining stem cells from the oral cavity for treatment later also in the oral cavity is an advantage. 

Within restorative dentistry, some possible benefits of using these stem cells from the oral cavity include the regeneration of periodontal tissue and the regeneration of dental pulp which would otherwise remain dead after root canal treatment.4  Furthermore, there are prospects to using non-dental stem cells for dental application including the use of urine to regrow teeth. 5 Researchers in China have harvested pluripotent stem cells derived from human urine and they were able to generate tooth-like structures. Even though large-scale testing has not been completed yet, the advantages of this include the low cost, non-invasive and the fact that these cells can be used rather than being ended up as waste. Also, these urine-derived stem cells do not form tumours in the body and rejection is highly unlikely. However, drawbacks include the fact that these generated teeth were only one third the hardness of normal human teeth.

One use of stem cells may be used as an alternative for root canal treatment. When dental fillings are required due to caries (cavity) being present, a dental professional will fill caries to prevent further tooth degradation and to protect the dental pulp. The dental pulp has to be protected to prevent pain and the eventual loss of the tooth. However, with severe caries, the pulp can be infected and root canal treatment has to take place to protect the tooth.  A perfectly healthy tooth has had to undergo invasive treatment and will fall out quickly due to infection which may be avoided using stem cells. The same invasive procedure would occur but instead of filling with cement, stem cells can be utilised to stimulate the regrowth of dentine and pulp. In 2016, scientists at the University of Nottingham and Harvard University designed synthetic biomaterials to be used in conjunction with stem cells to encourage the new growth of cells within the dentine and pulp layer of the mouth. 6 This would allow patients to regrow teeth that have been damaged through dental disease and the tooth can remain healthy for a much longer period within the patient. Stem cells evidently provide an alternative treatment plan for a patient but whether this should be implemented more has to be evaluated.

Moreover, stem cell treatment may be an option in regards to a replacement for dental implants. Dental implants act as new teeth and tooth roots within a patient as old teeth may be extracted due to a variety of complications such as disease. These implants ensure the jaw bones and teeth structure in the mouth remains stable whilst allowing the patient to acquire cosmetic advantages. Overall, a patient’s satisfaction is improved with implants as comfort, speech, as well as appearance, are enhanced. 7 So why should stem cells be considered when dental implants are seen to be successful? Despite the great benefits seen, the disadvantages include that the healing process of implants can be very long. These implants are only pieces of titanium and cannot adapt to how the jaw grows. Also, careful cleaning and monitoring have to be completed to ensure that further infection does not occur. 8 As an alternative option that is being researched, the utilisation of stem cells may create a better solution to implants and whole teeth may be able to be regrown. At King’s College London, human gum tissue and stem cells from mice teeth were able to undergo tooth formation. 9 With whole tooth production possible outside the human body, these teeth may be able to be grown and used as natural implants. The advantage to this would involve a natural tooth within the mouth with its blood supply. But is this a safe option to go towards?

As this essay has explored, restorative dentistry encompasses a wide variety of treatments that patients can receive and stem cells do provide an alternative plan of action for a patient. Even though the whole of restorative dentistry is so vast, certain aspects may benefit from such research. The main benefits include the natural approach to providing care for a patient and allowing a patient to preserve their teeth for a longer duration of time. At the same time, all stem cell use would have to be researched thoroughly before its usage increases within the community but researchers and scientists are hopeful this can happen soon as the current research is pointing in the right direction. The current models of research are mainly confined to animal models and the current state of the likelihood of immune rejection within the oral cavity is not completely known.5 Despite the current risks that are unknown, with continued thorough research within this area the whole field of dentistry can be benefitted. Whilst being wary of the risks involved, the future of restorative dentistry seems highly promising and stem cell therapies could be a fantastic tool in dental practices.


  1. n.d. Restorative dentistry. [online] Available at: 
  2. MacDonald, A., 2018. Cell Potency: Totipotent vs Pluripotent vs Multipotent Stem Cells. [online] Cell Science from Technology Networks. Available at: 
  3. A Closer Look at Stem Cells. n.d. Types of Stem Cells. [online] Available at:
  4. Ratan-NM and Pharm, M., 2020. Repairing Teeth using Stem Cells. [online] Available at: 
  5.  Jain, A. and Bansal, R., 2015. Current overview on dental stem cells applications in regenerative dentistry. [online] National Library of Medicine. Available at: 
  6. Cuthberton, A., 2016. Dental fillings heal teeth with stem cells. [online] Newsweek. Available at: 
  7. Frisbee, E., 2021. Dental Implants. [online] WebMD. Available at: 
  8. Shapiro, J., 2022. What are Stem cell dental implants ?. [online] Available at:,used%20to%20regrow%20teeth%20completely 


This article explores how continued research within the area of stem cell treatment may change the way restorative dental treatments are carried out.

Health and Disease

Nanoparticles in Dentistry

Nanoparticles have been recently developing as a tool to be used in a variety of industries, including the healthcare sector within medicine and dentistry for example. They are defined as small particles that are within 1 to 100 nanometres in size, undetectable by the human eye and can exhibit properties that would not be visible in the same material if it was larger. In making nanoparticles, different particles are combined to make materials lighter, more durable and more reactive. One common use of nanoparticles is in sunscreen to result in UV protection being more effective. However, I will be exploring the use of these nanoparticles within some different areas of dentistry and how they exemplify patient treatment.

One use of nanoparticles is the use of the oral tetracycline antibiotic which is a valuable treatment for periodontitis or gum disease. Periodontitis is characterised by chronic inflammatory gums, bleeding and maybe certain abscesses due to the accumulation of bacteria on teeth and gums. In certain patients, periodontal pockets can occur where there are spaces around the gum line that have become infected. These deep pockets with moisture are a thriving ground for bacteria and can cause serious pain for a patient. Tetracycline along with other treatments is an effective measure to alleviate the symptoms and treat the disease. One method of treatment of tetracycline involves the periodontist inserting and leaving tetracycline fibres within a pocket and this treatment is effective as it kills bacteria in very hard to reach areas. However, as with many medications there are drawbacks and children who receive this medication in the long term can lead to stunted tooth development and yellow teeth.

One field within dentistry involves oral and maxillofacial surgery and involves the treatment of diseases, injuries and defects in the head, neck, face and jaws. In most circumstances, oral cancer treatment involves a multitude of stages involving physical examination, biopsies and further examinations including nasendoscopies and panendoscopies. However, the utilisation of nanoparticles could result in faster and therefore earlier and better treatment. One area within nanotechnology is the use of quantum dots and research has been carried out to present quantum dots to be an exceptional tool in the diagnosis of oral cancer. These quantum dots can be coated with materials that make them attach to specific molecules. In this case, the quantum dots attach to unique proteins on the suspected cancer. Once these dots bind to any cancer cells in the vicinity, an ultraviolet light is shone and the attached quantum dots emit specific wavelengths of light. This method of diagnosis allows for the specific diagnosis of cancer as treatment can now be directed more carefully.

Furthermore, the dental specialty of orthodontics has begun to use nanoparticles as significant research has taken place. This speciality addresses the diagnosis, prevention and correction of misaligned teeth and jaws. With up to 45% of the population undergoing orthodontic treatment, using nanoparticles to aid this treatment to ensure better results will give patient satisfaction to a large majority of patients. Within orthodontics, specific tools involve brackets and wires and nanoparticles can make these tools better suited to their purpose. Orthodontic brackets are small attachments secured to a tooth to then attach to an arch wire which will slowly bring the teeth and jaw in a desirable position. One nanoparticle used in brackets are mono crystal alumina brackets which offer aesthetic qualities as well as high strength. It is vital these brackets stay within the patient as they provide tension alongside the wire to bring teeth into position over a long period of time. High strength ensures the bracket does not break during treatment and provides a strong structural support before the tight wire is fitted. Furthermore, if brackets are made out of mono crystal alumina, this material is almost clear allowing for greater aesthetic quality. Many patients are self-conscious about their appearance due to braces but with almost clear brackets, they will have more confidence in their appearance while they are undergoing the treatment. At the same time, instead of alumina, polycrystalline zirconia brackets may also be utilised which provide the greatest toughness but are very opaque and exhibit bold colours. Therefore, there is a balance between which material should be used.

Overall, nanoparticles in dentistry can be utilised and developed in a multitude of ways of which I have only covered a few. With the development within this sector still growing, patient care and satisfaction should increase. Perhaps in the future with a variety of materials available, patients will be able to make their own choice in their methods of diagnosis and treatment. This makes their treatment much more personalised to them.

Arya Bhatt, Youth Medical Journal 2022


Barot, T., Rawtani, D. and Kulkarni, P. (2021). Nanotechnology-based materials as emerging trends for dental applications. [online] De Gruyter. Available at:

Kanaparthy, R. and Kanaparthy, A. (2011). The changing face of dentistry: nanotechnology. International Journal of Nanomedicine, 6, pp.2799–2804.

ROOTDFW. (2022). Tetracycline. [online] Available at:

Zakrzewski, W., Dobrzynski, M., Dobrzynski, W., Zawadzka-Knefel, A., Janecki, M., Kurek, K., Lubojanski, A., Szymonowicz, M., Rybak, Z. and Wiglusz, R.J. (2021). Nanomaterials Application in Orthodontics. Nanomaterials, [online] 11(2), p.337. Available at:

Commentary Health and Disease

Importance of Oral Health

As the World Health Organization states in their definition, ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’ Oral health is determined by a multitude of factors and poor oral health affects the overall health of a person more than people believe. The main aspects of preventing oral diseases within the community involve the communication of the importance of diet, oral hygiene and regular check-ups.

Oral health can be maintained to a high standard with a suitable balanced diet. The more obvious trigger to decreased oral health is the consumption of high amounts of sugar. The sugars interact with plaque bacteria to produce acid and enamel degradation occurs. Even though this process is slow and the saliva’s minerals can reverse some damage to an extent, a lack of proper oral hygiene will exacerbate this demineralisation. Repeated degradation can lead to a cavity being formed and leaving it untreated, it can spread to lower layers of the teeth, causing pain. If bacteria invade the dental pulp, tooth abscesses can form, causing more pain. These infections are easily treatable but further delayed treatment can lead to further complications where infections spread to the head and neck and in extreme cases other parts of the body too. As well as a fall in physical health, a person experiencing chronic pain would be mentally affected and make them feel a lot worse. In addition, when only taking into account oral health, eating foods with sugar fewer times during the day is much better than many times during the day as a regular intake of sugar results in acid being present in the mouth for a longer period.

Poor nutrition also leads to multiple nutritional deficiencies which can cause many issues within the oral cavity. Vitamin A deficiency can lead to impaired tooth formation and an enamel defect called enamel hypoplasia can occur, which is characterised by thin or absent enamel. This also affects the skin within the mouth. A vitamin B deficiency can be caused by restricted diets such as veganism and it can lead to sores and ulcers within the mouth, swelling of the tongue and inflamed gums. Similar symptoms are experienced with a Vitamin C deficiency. Vitamin D deficiency affects the calcification and strength of teeth and bone. Vitamin D deficiency also makes it harder for your immune system to fend off infections within the mouth so periodontal disease occurring may be more likely. With these nutritional deficiencies and others occurring, pain and discomfort experienced by a person will reduce their intake of nutrition further as they find eating more of a challenge which would aggravate these conditions within the mouth.

In an attempt to improve the oral health of the community, since 1964 the UK has introduced water fluoridation schemes and since 2013 the government has urged local councils to introduce water fluoridation schemes further. In 2021 a bill was created to give the Secretary of State power to give further control of water fluoridation so it can be directly introduced, varied or terminated in different locations. Fluoride is a mineral in bones and teeth and within the oral cavity, it strengthens enamel to prevent cavities. These water fluoridation schemes have been put in place, not just in the UK but all over the world, to prevent dental caries within the whole population. In the UK, children’s tooth extractions cost hospitals approximately £50 million each year and most of these are preventable tooth decay. Research has shown that within the UK, by including drinking water with fluoridated water of at least 0.7mg/l, the number of people experiencing decay would fall by up to 28% in the most deprived areas. In addition, the number of extractions can be reduced by up to 68%. These systems being put in place improve oral health of communities immensely, especially in areas of socio-economic deprivation.  In cases of high intake of fluoride, skeletal fluorosis can occur, where symptoms of joint pain and stiffness can occur but only with long term intake of a large amount of fluoride. Dental fluorosis happens when too much fluoride is taken whilst teeth are forming under the gum and this can result in white spots on the teeth. Other than these white spots, no other harm occurs.

Overall, oral health is a vital aspect of being “healthy” as a person. With oral disease not only causing harm within the mouth but the reduced confidence of a person who has any form of an oral disease affects their mental state. This is why dentistry looks into helping a patient’s mental health too as treatments give patients self-assurance on how they appear to others.

Arya Bhatt, Youth Medical Journal 2022


Cafasso, J. (2019). What Is Fluoride, and Is It Safe? [online] Healthline. Available at:

GOV.UK. (2021). Health and Care Bill: water fluoridation. [online] Available at:

Middleton, A. (2020). How Poor Nutrition Affects Your Teeth l London Hygienist. [online] londonhygienist. Available at:

Scardina, G.A. and Messina, P. (2012). Good Oral Health and Diet. Journal of Biomedicine and Biotechnology, [online] 2012. Available at:

Tan, V. (2017). How Sugar Causes Cavities and Destroys Your Teeth. [online] Healthline. Available at:

Biomedical Research Health and Disease

Influence of Technology in Dentistry

As technology is already seen to be changing in many sectors of society, the development of new devices and systems to benefit the whole healthcare system, including dentistry, is definitely inevitable. New systems to benefit patients and dentists will overall lead to better patient-centred care. Some of these new technologies will be explored here and how this will impact the field in general.

One form of technology, which has been introduced within society for a while but only just begun to be utilized in dentistry, is Augmented Reality (AR) and Virtual Reality (VR). Augmented Reality uses visual elements to create an enhanced version of the real physical world by analysing the world in front of the viewer and adding filters. This has excellent uses in dentistry such as dental students using AR to practice procedures. Rather than using mannequin heads which cannot be used at all times, dental students can improve and develop their manual dexterity skills anywhere. In the dental practice, dental professionals can create accurate representations of patients’ teeth on a model and present them what their teeth should look like after treatment and procedures. This automatically creates a greater satisfaction and comfort for the patient about how their teeth can be improved, which can give them confidence and be less fearful of the whole process. It gives the patient a greater awareness of their problem and makes them more likely to undergo treatment without being skeptical. Furthermore, multiple AR models can be created with different aesthetics to present to a patient clearly what treatment they would like. This would overall lead to greater patient satisfaction. Similarly, these benefits can be seen for both the dentist and patient with Virtual Reality. VR involves a person wearing a headset to immerse themselves in a completely different environment to what they are actually in. This contrasts AR where a person can visualise something through a screen but would not experience the same immersion. For this reason, VR can be used by training dentists and dental students to observe a real procedure and learn how to carry it out from an experienced dentist’s perspective. Learning from a third person perspective would not be as engaging. Using VR would mean students would learn much more effectively and even practice these skills with greater understanding. Similarly, for patients needing specialist care or patients who are fearful of procedures, VR headsets can be used to make the environment more comforting for them, which also makes the procedure easier for the dentist to complete.

Furthermore, the use of Artificial Intelligence (AI) has been utilized to analyse data throughout many aspects of society and has excellent opportunities in the field of dentistry too. AI algorithms have already been set up to analyse huge amounts of data to find the best treatment options for patients. Health data, research and treatment techniques can be analysed as a whole to offer diagnostic recommendations for individual patients. Further collection of data and analysis, such as with genomic data would offer a deeper understanding into each person, providing a better personal care. With AI having access to such information, better treatment options are available. However, one drawback of this is that the handling of such huge amounts of data has to be done with care as practices may be susceptible to data hacks and leaks which would ruin patient privacy and confidentiality. However, with such large-scale data processing, much better security systems would be in place too. Another implementation of AI on a larger scale could involve the use of smart toothbrushes. With our homes being filled with smart devices, the use of a smart toothbrush would improve our lives further. Used in conjunction with an app, a variety of sensors in the toothbrush analyse the method with which the user is brushing their teeth and while scanning the area of the mouth, the user can be notified on how to improve their brushing. With real time feedback on whether too much pressure is applied, which areas have been missed and which technique should be used, over time the user’s oral health would improve greatly. At the expense of these benefits, there are some negatives which include the extent to which data is being collected while these systems are used, which would put off some consumers.

In addition to all of these, multiple technological advancements, including in robotics, allow for a better treatment for the patient and follows the philosophy of patient-centred care to a greater extent. For example, intra-oral cameras have begun to be utilized by dentists to view harder-to-see areas of the mouth in greater detail. When complex procedures occur, the site has to be inspected clearly and intra-oral cameras ensure no abnormalities are missed. Similarly, as such a huge number of patients receive dentures every year all over the world, intra-oral scanners play an amazing role in the production of dentures. Normally, when an impression of the teeth has to be made, a thick liquid material, usually alginate or polyvinyl siloxane, is set in the patient’s mouth before a set of dentures can be made. This has to be sent to a lab to make a set of dentures for a patient. However, using intra-oral scanners means that a quick digital impression of the teeth can be formed with just one tool and this digital scan of the patient’s mouth can be sent to the lab. The process of creating an impression is much faster and is much easier for the patient. The resulting denture will be more accurate too which results in better patient satisfaction too. Furthermore, as dental practices regularly send impressions to dental labs, some dental implants could be made by the dentist itself with the help of 3D printing. Using the same digital scanning technique but instead creating an implant quickly for a patient makes the whole process faster. Rather than running a whole dental laboratory, dentists can 3D print certain implants and money can be saved, which results in patient expenditure falling too and costs reduced. The greater accuracy too leads to better results. Furthermore, the actual procedure of setting implants within the patient can be assisted with technology too, such as with the use of the YOMI robotic system which increases accuracy of procedures whilst ensuring safety.

The technologies utilized in dentistry allow for an excellent improvement to patient care as procedures become more accurate and patients are satisfied with their results which mirrors the dentists aim of providing patient centred care.

Arya Bhatt, Youth Medical Journal 2022


The Medical Futurist. 2020. 9 Technologies That Will Shape The Future Of Dentistry – The Medical Futurist. (online) Available at:

Evanson, A., n.d. How 3D Printing Is Revolutionizing Dentistry. (online) Evanson DDS. Available at:

n.d. Professional 3D Printing Materials. (online) Available at:

Health and Disease

Evolution of Materials in Dental Fillings

By Arya Bhatt

Published 2:03 EST, Weds December 29th, 2021

Dental materials are essential in numerous treatments including plaque removal, fillings, aesthetic interventions, and more. For thousands of years, the types and uses of dental materials have adapted and evolved as technology has improved and better materials have been discovered and formed to provide the best care for the patient.

One use of dental materials is in tooth fillings where a cavity in the tooth has to be repaired by filling in a hole to ensure further decay does not occur whilst achieving aesthetic quality for the patient. The earliest evidence of fillings dates back over 13,000 years ago where the remains of a person who lived in what is known now as northern Italy has been found to have sizeable holes in their teeth with evidence of some drilling. The report from 2017 included that there was evidence of bitumen, a tar-like substance, to fill the teeth. Using bitumen for fillings in the 21st century would not only be unsuccessful but uncomfortable for the patient too.

Furthermore, the oldest surviving dental fillings date back to approximately 6500 years ago where a cracked canine tooth was discovered to have beeswax filling and was discovered by researchers in 2012. In addition, the use of gold in dentistry also dates back thousands of years where gold crowns were utilized in the year 201. Gold fillings began to be utilized in the 1800s due to their soft nature and making it easy to fill cavities. Today, gold fillings are possible but are much more expensive and more noticeable compared to other alternatives.

Still, in use today is the use of amalgam fillings which first appeared to be used in the year 659 in China and a written formula was also published in China by the year 1505. Modern amalgams were introduced in the 1800s where small amounts of mercury were added to silver and in 1806, French dentist Auguste Taveau used this material as a dental restorative and filler. At this time, this dental filler included some practical issues as it tended to expand significantly after setting. However, mercury is soft enough to mold effectively whilst setting hard and lasting for a long duration after curing. This composition of amalgam has slightly changed over the years since the 1800s and nowadays contains mercury, silver, tin, and copper.

But one controversy that still exists today involved the risks of mercury in amalgam fillings. The effects of mercury on the body are seen to be devastating and some argue that even though only very minute amounts of vapor are present, amalgam fillings should no longer be used. Some autopsy studies from people with amalgam fillings have shown that individuals with amalgam have toxic levels of mercury in their brains or kidneys. However, the US FDA has stated that in most cases, dental amalgam does not lead to negative health effects but may pose a greater risk in certain groups, such as pregnant women and those with impaired kidney function. The UK’s NHS states that mercury from amalgam fillings does not have any harmful effects on health. Overall, there may be some evidence found that some harmful effects may occur but currently there is not sufficient evidence to make a clear claim or to make amalgam banned from use in dental fillings.

The most popular filling material for a variety of reasons today is composite. These fillings are made up of powdered glass quartz, silica, or other ceramic particles which are then added to a resin base. This filling material is built up in layers and set with UV blue light. One of the many advantages of this material is that it matches with the color of the tooth making it a better aesthetic choice for patients. Even though they are very durable, amalgam fillings are seen to have a longer lifespan within the mouth and composite fillings are more expensive and require a longer procedure by the dentist to put in place. At the same time, many patients are put off by amalgam due to the metallic look which isn’t natural.

In regards to the future, there are already some excellent materials being developed to make fillings even more effective. New composites, made of bioactive glass, help repair tooth decay through the release of fluoride, calcium, and phosphate. Standard amalgam and composite fillings just fill the cavity but these new composites replenish minerals to form new tooth material and prevent oral bacteria from infiltrating the tooth further.

Overall, the use of dental materials in fillings has developed over many years, with the sole purpose to improve the quality of the fillings for the patient. As new materials have been tried and tested over time, it is evident that some are better than others in their own ways but at the end of the day it is the patient’s choice and it is in the dentist’s best interest to help the patient and fix their cavity.

Arya Bhatt, Youth Medical Journal 2021


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Health and Disease

Artificial Intelligence in Healthcare

By Arya Bhatt
Published 2:57 EST, Sun December 19th, 2021

Artificial intelligence in healthcare requires human intelligence and input. As technology has vastly developed and is already a huge part of our lives in the 21st century, it’s only expected to get better. Tasks involving visual perception, complex decision-making, and other operations have only been possible with human input. Still, various technologies are now available to make jobs for humans much easier and more efficient.

One fantastic implementation of this has been seen in robotic surgery. Carrying out surgery on any level requires excellent strength in manual dexterity and concentration. With the instruments being used to aid surgeons in completing surgeries with great efficiency are already of a high level and complexity, the robots being continuously developed are able to complete actions almost autonomously due to the sheer development of artificial intelligence. For example, the Da Vinci surgical system is able to complete some surgeries completely without human input. Even though there are some ethical arguments against completely autonomous robotic surgery, it is highly efficient. With correct implementation, the results will be far better for the patient too. Furthermore, this artificial intelligence in robotic systems has been applied in dentistry too. A robot in China has successfully been able to fit dental implants into a patient without any human involvement. The surgical report mentioned that this system could be an excellent tool to aid dental surgeons when working in small spaces in the mouth. As artificial intelligence has developed in systems in robotic surgery, the ideas of visual perception and decision making can be mimicked by the robot to a great degree of detail, resulting in more successful surgeries and better results. At the same time, initial thoughts from some fear that these systems used extensively may lead to some surgeons becoming redundant, but this is highly unlikely due to the extent of monitoring required. The future will likely involve a larger proportion of surgeries to be robotically assisted by surgeons rather than be completely autonomous.

Furthermore, artificial intelligence has even been utilised to manage the COVID-19 pandemic. With machine learning being an integral part of A.I., it has been utilised to assess data from a multitude of lung scans, improving treatment options and even identifying variants. A.I. has been used to forecast the spread of COVID-19 as analysing large volumes of data is impossible with just human brain power. Detecting patterns and forming predictions of consequences have been an integral part of the model created at the Chan Zuckerberg Biohub in California. Even the use of chatbots to communicate to the public about their questions about COVID-19 has ensured healthcare resources are not strained.

Imaging and scans are an ever-existing part of the healthcare sector. They allow for an in-depth view of the human body to diagnose, monitor, and treat healthcare conditions without a physical intrusion. In radiology, A.I. and machine learning can aid radiologists in diagnosing certain conditions that may be difficult to spot at first. It is evident that radiologists are trained to recognise these patterns but utilising machine learning will allow for a greater in-depth analysis of how scans/images have changed over time, leading to a better diagnosis for a patient. At the same time, if these systems are put in place in the general healthcare sector, they need to be highly developed to identify conditions just from an image. This form of machine learning resolution takes a long time to be very successful and ensure widespread use. Care has to be taken to make sure nothing is missed, so, in the present, trained radiologists who are aware of how to identify conditions from scans should be the ones making diagnostic decisions.

Overall, from this insight into how A.I. is used in the healthcare sector, it can be seen that with the conjunction of A.I. and technology, patient diagnosis and care can be completed to a higher level, resulting in a better quality of life for all patients and therefore a healthier population. Even though the technology is still far from being used in all environments, recent developments have already shown that the future is promising.

Arya Bhatt, Youth Medical Journal 2021


Miyanger, V., 2019. Robot dentist in China is first to fit implants in patient without any human involvement. (online) Available at:

Sivasubramanian, S., 2020. How AI and machine learning are helping to tackle COVID-19. (online) World Economic Forum. Available at:

Loria, K., 2021. Putting the AI in Radiology. Radiology Today, (online) Available at:

Biomedical Research

HeLa Cells: The Turning Point of Medicine?

By Arya Bhatt

Published 2:47 EST, Sun October 31st, 2021

Henrietta Lacks, a black tobacco farmer who died from cervical cancer at the age of 30 in 1951. For many years, scientists were attempting to culture human cells for medical research purposes. Observing how diseases would interact with cells whilst attempting to make beneficial cures is just one example. But the lack of information on required conditions for culture, and how easily these cells would die limited this research greatly. Now that medical knowledge has advanced and knowledge has grown, scientists are aware of the basic conditions required for optimum cell culture. First, all cells require twelve amino acids to synthesize proteins. Furthermore, glutamine is another essential component in the metabolism process. In addition, as expected, cells require a suitable pH of around 7.2 to 7.4, otherwise, there will be harmful effects. But supplying all the nutrients in correct proportions is still problematic and even after those cells are likely to die. Currently, the best form of human cell culture used is embryonic stem cells but this does not provide the greatest depth of research. However, in 1951 a scientist named Dr. Gey observed something extraordinary.

For many years, he was attempting to stimulate the growth of human cells in culture but did not achieve success. One day, when Lacks came into John Hopkins Hospital for a procedure, a small section of her tumour was removed from the cervix and sent to the lab. Dr Gey repeated his experiment as he did with other tumours and cells by setting the sample in his lab to culture. Within a day, he had seen the cells had doubled and needed more space to grow. This process continued until he noticed that the cells would never die as long as the correct space and nutrients are given. The first ‘immortal cells.’ These cells continue to be cultured today and even sent around the world for further medical research. But why were Lacks’ cells so special? The exact reason is unknown but is said that it is a combination of her cancer case being uniquely aggressive, the cells having multiple copies of the HPV genome and the fact that Lacks had syphilis, which weakened her immune system and allowed the cancer to spread further. With her biopsy sample doubling every 20 to 24 hours whilst others would die out meant later on that Dr. Gey created the ‘HeLa cell’ line and was available to researchers for free. These cells did become commercialized later but were not patented and Dr. Gey did not profit from this.

The use of these cells has been magnificent in the field of research and will still continue to be incredibly valuable. For instance, Lacks’ cells have been used to develop vaccinations for Human papillomavirus (HPV). It was seen that the virus entered cells and turned off the gene that would normally suppress the formation of tumours. This knowledge led to the vaccine being developed years later and reduced deaths from HPV by almost two-thirds. But this is quite a specific use as Lacks’ cells were already infected with HPV. There have been multiple wide-scale uses of the cells too. At the time of Lacks’ death, polio was one of the world’s most devastating diseases. HeLa cells helped make the vaccine sooner. Virologist and researcher Jonas Salk figured how the vaccine would work but did not have an efficient testing method. Initially, monkeys’ cells were used which not only killed the cells but were very expensive too. By using HeLa cells, the cells were susceptible to the virus whilst not being killed. This efficient testing method has ensured polio has been eradicated in most countries around the world over the last 60 years.

Furthermore, HeLa cells were utilised in mapping the human genome. HeLa cells were fused with mouse cells creating hybridoma cells. As each hybridoma would have a different combination of genes, scientists could look at what proteins a cell could or could not produce which helped deduce which human gene they were produced by. As HeLa cells can be reproduced in high numbers, they were definitely viable for a study like this. Also, other studies include how human cells are affected when exposed to X-rays and even how Salmonella causes infection. In 1964, HeLa cells were used to study the potential treatment benefits of the Hydroxyurea drug against certain blood cancers and sickle cell anaemia. It showed that Hydroxyurea helps prevent the misshapen red blood cells caused by the genetic mutation responsible for sickle anemia. In the same year, HeLa cells were even sent to space to provide details on how human cells will react to radiation in space when manned missions take place and how astronauts will be impacted. Even now, HeLa cells have been used to study the viral infectivity of SARS-CoV-2 in humans. Studies and research found that coronavirus enters some cells through ACE2 molecules. HeLa cells were engineered to display ACE2 and scientists analyzed how the virus could enter and infect cells.

The development of HeLa cells has evidently been a fantastic breakthrough but is it truly viable and fair? The cells have been used in medical research all over the globe but no one ever asked Lacks consent for the extraction of the tumor cells in the initial procedure. The story of Henrietta Lacks illustrates the deep problem of racial inequality in the US at the time but the main argument involves the fact that healthcare professionals did not obtain consent, and Lacks had no knowledge of her cells being utilised in this manner. So, the use of these cells may be unethical and ‘perpetuates an injustice.’ There are many arguments that the use of HeLa cells should be reduced or even entirely put to a stop. But one thing people need to acknowledge is that each sample in a lab is from a person who has their own life, even if they are helping save numerous lives in the future and contributing to one of the greatest medical research tools.

Arya Bhatt, Youth Medical Journal 2021


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Health and Disease

Stem Cells in Dentistry: A Regenerative Future?

By Arya Bhatt

Published 1:25 EST, Thurs October 21st, 2021

 As seen in a variety of medical applications over multiple years of development, stem cells have been an extraordinary treatment tool for many people. Whether that has been for treatment of blood diseases, fighting cancer or as a method for tissue regeneration, stem cells are continually being developed for the betterment of the whole human population. Now with research in this field escalating on new levels due to the many benefits found, stem cells have been obtained, observed from teeth and put into many dental applications. With multitudes of research that has taken place and will take place in the future, there are excellent prospects of this treatment being widely used as part of dental treatment.

The discovery of stem cells in dental pulp (a layer underneath dentine made up of connective tissue) has vast benefits. Unlike other living organs, teeth possess a limited capacity to repair itself. Furthermore, the anatomy of a tooth is complex and does not just involve the outer layer of enamel we are all aware of. Tooth repair with these stem cells may have much better results which leads to better patient satisfaction and reduced likelihood of complications.

One use of this treatment involves the use of regenerative dental fillings that allow teeth to heal by themselves. The tooth filling would work by stimulating stem cells to encourage the growth of dentine– the main bony material under the hard enamel, which would effectively allow patients to regrow teeth that are damaged through dental disease. The stem cells are obtained from human exfoliated deciduous teeth (SHED). If these treatments are effective and begin to be used in many patients, these patients would be much happier with the result and makes their process of visiting the dentist less intimidating. For example, if a patient’s pulp has been damaged by a bacterial infection, they would normally need a root canal treatment and many are afraid to get this treatment completed due to it being more of an invasive procedure. On the other hand, if stem cell treatments are available, more people would be willing to undergo a simple “filling” to help them recover, and the overall oral health of the community would improve as patients are less hesitant to undergo treatment.

Furthermore, periodontal ligament stem cells are proposed to be effective in periodontitis (severe gum disease). Currently, tests have been completed on pigs and when these stem cells have been transplanted into surgically created periodontal defect areas,which have been seen to regenerate. This could be a favourable treatment method. Rather than a sole relyment on good oral hygiene and professional cleanings in the latter stages of periodontitis, this irreversible disease can be treated to a much higher standard.

However, even though dental treatments using stem cells seem highly attractive, there are some drawbacks. Even when ignoring costs which are currently high for stem cell usage, it is important to note that the obtaining of stem cells from a patient cannot be done at just any point of their lives. Availability is much greater at a younger age. A comprehensive storage solution of these cells would have to be devised.

In the future, if a whole organic tooth can be grown in place of a lost one, this could have fantastic prospects for patients. Rather than being forced to use dentures or having an artificial crown implanted, which can result in complications, a more natural tooth could fill the gap. Patient treatments would be able to be much more personalised, avoiding other complications and challenges. At the moment, treatment is mostly successful with the exception of the misalignment of teeth, rejection that can occur, and the fact that implanted crowns may fall out after insertion if the bone underneath deteriorates. 

In conclusion, dental stem cells are showing a promising future for patient treatment. At the moment, with dental treatment having developed over the years and still not finding vast improvement, it is hard to see where new research will be able to take us. At the moment, dental treatment is highly successful and even greatly satisfying for the patient due to the large number of aesthetic options available. But if research in this area is moved further and is available for a wider use for all patients, the patient satisfaction will greatly improve along with the oral health of the general community.

Arya Bhatt, Youth Medical Journal 2021


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