Academic literature on the topic 'Dental Pulp Diseases'

Endodontic regeneration shows promise in treating dental pulp diseases; however, no suitable scaffolds exist for pulp regeneration. Acellular natural extracellular matrix (ECM) is a favorable scaffold for tissue regeneration since the anatomical structure and ECM of the natural tissues or organs are well-preserved. Xenogeneic ECM is superior to autologous or allogeneic ECM in tissue engineering for its unlimited resources. This study investigated the characteristics of decellularized dental pulp ECM from swine and evaluated whether it could mediate pulp regeneration. Dental pulps were acquired from the mandible anterior teeth of swine 12 months of age and decellularized with 10% sodium dodecyl sulfate (SDS) combined with Triton X-100. Pulp regeneration was conducted by seeding human dental pulp stem cells into decellularized pulp and transplanted subcutaneously into nude mice for 8 weeks. The decellularized pulp demonstrated preserved natural shape and structure without any cellular components. Histological analysis showed excellent ECM preservation and pulp-like tissue, and newly formed mineralized tissues were regenerated after being transplanted in vivo. In conclusion, decellularized swine dental pulp maintains ECM components favoring stem cell proliferation and differentiation, thus representing a suitable scaffold for improving clinical outcomes and functions of teeth with dental pulp diseases.

Abstract Background: Dental pulp calcifications or pulp stones are calcified structures found in dental pulp, mostly around or enclosing a blood vessel. The formation of these calcifications begins with concentric layers of calcified tissue within which remnants of necrotic and calcified cells may be present. The calcifications of thrombi in blood vessels, called phleboliths, may also serve as nidi for denticles. In metabolic diseases such as diabetes, hypertension or poor periodontal health, there are obvious changes in blood vessels and vascularization. In our study, we observed histopathological sections of dental pulp and correlated systemic diseases such as diabetes and hypertension with poor periodontal health and dental pulp stones. Aim: The aim of our study was to evaluate the histopathology of dental pulp stones, their distribution among various age groups and sexes and to identify any correlations between pulp stone formation and systemic diseases such as type II diabetes and hypertension. Materials and Methods: Samples from 100 patients with metabolic diseases such as type II diabetes and hypertension were collected. The pulp was extirpated from the teeth that were undergoing root canal treatment, and the teeth were extracted. The collected pulp sample was fixed in 10% formaline neutral buffer, subjected to routine histopathological procedures and stained with haematoxylin and eosin. The pulp of teeth extracted for orthodontic treatment was considered a control for patients with no metabolic disease. Results: There was a definite relationship between increased pulp stones and metabolic diseases such as type II diabetes and hypertension; likewise, poor periodontal health was significantly related to pulp stones.

Aim. To estimate the prevalence of coronal pulp stones in the molar teeth of dental outpatients of Sunam, Sangrur district, Punjab, India, to report any association between occurrence of pulp stones with age, gender, dental arch, side, and dental status and to find out correlation between pulp stones with dental and systemic diseases. Materials and Methods. 500 routine dental outpatients within age group of 18–67 years were involved in the study. Molar bitewing of left and right side of each patient was taken with XCP bitewing instrument and size 2 film. The presence or absence of pulp stones was recorded. Chi-square analysis was used to record the prevalence of pulp stones and to compare it with demographic and systemic factors. Results. Overall prevalence of pulp stones was 41.8%. Pulp stones were significantly higher in maxilla (11.59%) than mandible (6.54%), left side than right side, and first molar than other molars. Higher numbers of pulp stones were recorded in patients with cardiovascular disease (38.89%) than with cholelithiasis and renal lithiasis. Conclusion. Pulp stones were higher in maxillary arch than mandibular arch and in females than males. Cardiovascular patients had higher number of pulp stones than other groups.

The cellular metabolic processes ensure the physiological integrity of the dentine-pulp complex. Odontoblasts and odontoblast-like cells are responsible for the defence mechanisms in the form of tertiary dentine formation. In turn, the main defence reaction of the pulp is the development of inflammation, during which the metabolic and signalling pathways of the cells are significantly altered. The selected dental procedures, such as orthodontic treatment, resin infiltration, resin restorations or dental bleaching, can impact the cellular metabolism in the dental pulp. Among systemic metabolic diseases, diabetes mellitus causes the most consequences for the cellular metabolism of the dentine-pulp complex. Similarly, ageing processes present a proven effect on the metabolic functioning of the odontoblasts and the pulp cells. In the literature, several potential metabolic mediators demonstrating anti-inflammatory properties on inflamed dental pulp are mentioned. Moreover, the pulp stem cells exhibit the regenerative potential essential for maintaining the function of the dentine-pulp complex.

Dental pulp and periapical diseases make patients suffer from acute pain and economic loss. Although root canal therapies, as demonstrated through evidence-based medicine, can relieve symptoms and are commonly employed by dentists, it is still difficult to fully restore a dental pulp’s nutrition, sensory, and immune-regulation functions. In recent years, researchers have made significant progress in tissue engineering to regenerate dental pulp in a desired microenvironment. With breakthroughs in regenerative medicine and material science, bioactive scaffolds play a pivotal role in creating a suitable microenvironment for cell survival, proliferation, and differentiation, following dental restoration and regeneration. This article focuses on current challenges and novel perspectives about bioactive scaffolds in creating a microenvironment to promote dental pulp regeneration. We hope our readers will gain a deeper understanding and new inspiration of dental pulp regeneration through our summary.

Dental pathologies such as caries is one of the most prevalent diseases worldwide. Dental pulp contains stem cells capable of regenerating the dentine in the tooth, consequently, healthy dental pulp is essential for long term tooth survival. The aim of this study was to incorporate a variety of polymers that provide strength, an antibacterial substance and a protein-based polymer to provide cell support. These components were combined into a triphasic hybrid dental biocomposite (3HB), that together could provide regenerative properties for the pulp tissue. The 3HB biocomposite was incorporated into Organic–inorganic nanostructured materials such as Mineral Trioxide Aggregate (MTA) as a base to assemble a hybrid dental biocomposite. The effects of the 3HB on cytotoxicity was examined in mouse dental pulp cells, MDPC-23. In vitro studies showed that 3HB supported the proliferative growth of the cells significantly more than the no treatment control. 3HB also caused little stress to the cells and supported cell viability. Fourier transform infrared (FTIR) spectra confirmed the presence of polymer functional groups within the 3HB biocomposite. Therefore, 3HB compound has the potential to be applied as a pulp wound dressing providing superior cytocompatibility than the present options but also may be indispensable for the regeneration of dental pulp.

Dental pulp stem/stromal cells (DPSCs) are fibroblast-like, neural crest-derived, and multipotent cells that can differentiate into several lineages. They are relatively easy to isolate from healthy and inflamed pulps, with little ethical concerns and can be successfully cryopreserved and thawed. The therapeutic effects of DPSCs derived from animal or human sources have been extensively studied through in-vitro and in-vivo animal experiments and the findings indicated that DPSCs are effective not only for dental diseases but also for systemic diseases. Understanding that translational research is a critical step through which the fundamental scientific discoveries could be translated into applicable diagnostics and therapeutics that directly benefit humans, several clinical studies were carried out to generate evidence for the efficacy and safety of autogenous or allogeneic human DPSCs (hDPSCs) as a treatment modality for use in cell-based therapy, regenerative medicine/dentistry and tissue engineering. In clinical medicine, hDPSCs were effective for treating acute ischemic stroke and human exfoliated deciduous teeth-conditioned medium (SHED-CM) repaired vascular damage of the corpus cavernous, which is the main cause of erectile dysfunction. Whereas in clinical dentistry, autologous SHED was able to regenerate necrotic dental pulp after implantation into injured teeth, and micrografts enriched with autologous hDPSCs and collagen sponge were considered a treatment option for human intrabony defects. In contrast, hDPSCs did not add a significant regenerative effect when they were used for the treatment of post-extraction sockets. Large-scale clinical studies across diverse populations are still lacking to provide robust evidence on the safety and efficacy of hDPSCs as a new treatment option for various human diseases including dental-related problems.

Human dental pulp-derived stem cells have varied applications in regenerative medicine. Dental pulp stem cells (DPSCs) are considered to be neural crest cells. They are known to have higher regenerative potential than the bone marrow-derived mesenchymal stem cells. DPSCs have multipotency, immunomodulatory function, and self-renewal capacity. They are highly proliferative, clonogenic and are capable of differentiating into adipocytes, neural cells, odontoblasts, and various other cells. DPSCs are effective for various diseases, such as spinal cord injuries, Parkinson’s disease, Alzheimer’s disease, cerebral ischemia, myocardial infarction, muscular dystrophy, diabetes, liver diseases, eye diseases, immune diseases, and oral diseases. This article provides an overview of properties and regenerative applications of human DPSCs.

Pulpal and periapical diseases account for a large proportion of dental visits, the current treatments for which are root canal therapy (RCT) and pulp revascularisation. Despite the clinical signs of full recovery and histological reconstruction, true regeneration of pulp tissues is still far from being achieved. The goal of regenerative endodontics is to promote normal pulp function recovery in inflamed or necrotic teeth that would result in true regeneration of the pulpodentinal complex. Recently, rapid progress has been made related to tissue engineering-mediated pulp regeneration, which combines stem cells, biomaterials, and growth factors. Since the successful isolation and characterisation of dental pulp stem cells (DPSCs) and other applicable dental mesenchymal stem cells, basic research and preclinical exploration of stem cell-mediated functional pulp regeneration via cell transplantation and cell homing have received considerably more attention. Some of this effort has translated into clinical therapeutic applications, bringing a ground-breaking revolution and a new perspective to the endodontic field. In this article, we retrospectively examined the current treatment status and clinical goals of pulpal and periapical diseases and scrutinized biological studies of functional pulp regeneration with a focus on DPSCs, biomaterials, and growth factors. Then, we reviewed preclinical experiments based on various animal models and research strategies. Finally, we summarised the current challenges encountered in preclinical or clinical regenerative applications and suggested promising solutions to address these challenges to guide tissue engineering-mediated clinical translation in the future.

The purpose of this study was to determine duration time, breakage and apical displacement, whilst using six different endodontic filing systems to prepare molar teeth. A total of 96 molar teeth were used in the study, divided equally, ie 16 teeth per system selected randomly, totalling 48 canals per system. A standardised access cavity was prepared for all the teeth before selection. The canals were filed according to the manufacturers&rsquo
guidelines. The result showed that PROTAPER®
, K3&trade
and the combination of: HERO Shaper®
, HERO Apical®
and Endoflare®
(Referred from hereon as HERO System for convenience) were statistically faster than PROFILE®
and FlexMaster®
, which were in turn faster than AETTM. Although breakage did occur in K3&trade
and HERO System this was not deemed statistically significant. Apical displacement occurred in the form of Type 1 in the AETTM, PROFILE®
and HERO System, but once again this was not statistically significant. It was concluded that more aggressive cutting features such as a positive rake
angle, pyramidal shaped tip, progressive taper and absence of radial lands, if present, could have enabled K3&trade
, HERO System and PROTAPER®
to have faster times, and in addition these features did not compromise these systems with regard to apical foramina transportation and breakage.

The aim of this PhD thesis was to study experimental approaches for revitalization of necrotic teeth. Revitalization, also known as regenerative endodontic procedures (REPs), is a relatively new treatment for necrotic teeth which tries to regenerate the dentine-pulp complex instead of obturating the root canal with biologically inert materials (root canal treatment). Until very recently, the most reliable option for the treatment of immature necrotic teeth was apexification followed by root canal treatment. However, endodontically treated teeth remain devitalized throughout the patient's lifetime and therefore defenceless to new caries lesions, as the absence of pulp implies the lack of tooth immune mechanisms. On the contrary, the regeneration of the dentine-pulp complex allows further root development and aims to recover the natural immune and secretory system of the pulp, making teeth more resistant to future lesions or traumatisms. The therapy was developed to treat necrotic immature teeth (i.e. those that have not completed their root development). Clinically, the outcomes can be considered successful since there is a resolution of the symptomatology, healing of the apical pathosis and further root development in most cases. However, histological analysis has demonstrated that the tissues formed after the therapy are reparative tissues – such as cementum-like tissue – instead of dentine, as well as an unorganized connective tissue, instead of pulp with its characteristic odontoblast layer. Currently, numerous efforts are being made to shed light on the clinical and biological aspects involved in the regeneration of pulp. Chapter 1: As previously said, evidence shows that no dentine but reparative tissues (cementum-like tissue) are responsible for the root development after regenerative endodontics. As cementum is less hard and less elastic than dentine, the question arises whether a root with apposition of cementum can endure mechanical stress similarly to roots completed by dentine. Thus, one of the objectives of this thesis was to compare the biomechanical performance of cementum- and dentine-reinforced teeth, and therefore to evaluate the biomechanical advantages of dentine regeneration after regenerative endodontics. We developted a finite element model of cementum- and dentinereinformed teeth and studied the stress distribution after the simulation of biting, trauma and orthodontic movement. The results showed that apposition of hard tissue (whether cementum or dentine) after REPs reduces mechanical stress on 17 immature teeth and, more important, that the formation of dentine is advantageous because it, unlike cementum, facilitates an even stress distribution throughout the root. As far as we know, ours was the first study showing the biomechanical advantages of dentine regeneration. Chapter 2: Odontoblasts are post-mitotic cells that secrete dentine. The isolation and culture of odontoblasts may open numerous possibilities to study this cell type under standardized conditions, shedding light on their roles in dentine formation, immune defence and transmission of external stimuli. We evaluated different protocols of enzymatic treatment to isolate primary odontoblasts from human molars. The results showed that, regardless of the enzymatic solution used, odontoblasts in culture did not remain viable after 24 h. Additionally, we identified increased expression of nestin (NE), bone sialoprotein (BSP) and dentine matrix acidic phosphoprotein 1 (DMP1) in the odontoblast layer compared to pulp fibroblasts. Though primary odontoblasts can still not be cultivated after isolation, characteristic genes were identified to differentiate odontoblasts from pulp fibroblasts. Chapter 3: We analysed the effects of autologous platelet concentrates (APCs) in the clinical and histological outcomes of the therapy and the different clinical protocols clinically used through systematic reviews. The results indicated that APCs improve the clinical and radiographic outcomes of regenerative endodontics since the teeth treated with APCs achieved significantly better thickening of the dentine walls and root lengthening. However, true regeneration of pulp was not achieved with the addition of platelet concentrates, which only stimulated tissue repair. Additionally, most of the studies did not follow a standard clinical protocol for regenerative endodontic therapy and used irritant and intracanal medicaments that are cytotoxic and affect the differentiation and adherence of the stem cells. Chapters 4 and 5: As will be mentioned in detail, a small apical foramen acts as a physical barrier that hinders tissue ingrowth into the root canal and therefore reduces the possibility of revitalization of mature teeth. We studied different methods for apical foramen enlargement of mature teeth as a basis to apply it in a further animal study. We analysed manual instrumentation at different working lengths and apicoectomy on extracted human teeth and in situ teeth. We concluded that apicoectomy is not an effective technique for apical foramen enlargement and therefore should not be used for that purpose. Instrumentation 18 0.5mm beyond the apex resulted in the most effective technique. Later, we performed an animal study and evaluated pulp tissue regeneration/repair in mature teeth and the differentiation of the stem cells from the periapical tissues into odontoblast-like cells by adding preameloblast-conditioned medium. Preameloblast-conditioned medium was applied in pulpectomized ferret canines, whose apical foramina were enlarged using the previously developed method. We observed vascularized connective tissue occupying the apical third of the canal space in 50% of the teeth, showing the potential of revascularization of mature teeth. However, no odontoblast-like cells were observed showing that in vivo odontoblast-like differentiation of stem cells is still not possible with the tested technique. Chapter 6: Finally, we present here the preliminary data of characterization and odontoblast-like differentiation of amnion epithelial cells. Human amnion epithelial cells (hAECs) express pluripotent stem cell markers and have been proven to differentiate in cells of the three embryologic layers. However, as far as we know, these are the first experiments that have proved the potential of odontoblast-like differentiation of these cells in vitro. To induce the odontoblast-like differentiation, we seeded hAECs over dentine disks treated with EDTA and evaluated the morphological characteristic of cells. We observed that hAECs present a characteristic odontoblast-like morphology, with cytoplasmic processes located in dentinal tubuli, after 48 h. Further studies will be carried out with known concentrations of dentine matrix proteins and qPCR.
El objetivo de esta tesis doctoral fue estudiar enfoques experimentales para la revitalización de dientes necróticos. La revitalización o endodoncia regenerativa es un tratamiento nuevo para dientes necróticos que busca regenerar el complejo dentino-pulpar, en lugar de obturar el conducto radicular con materiales biológicamente inertes (obturación radicular). Los dientes tratados endodónticamente permanecen desvitalizados durante toda la vida del paciente y, por lo tanto, indefensos ante nuevas lesiones de caries, ya que la ausencia de pulpa implica la falta del mecanismo inmune del diente. Por el contrario, la regeneración del complejo dentino-pulpar permite un mayor desarrollo de la raíz y tiene como objetivo recuperar el sistema inmune y secretor natural de la pulpa, haciendo que los dientes sean más resistentes a futuras lesiones o traumatismos. En esta tesis doctoral se realizó un estudio de elementos finitos que probó por primera vez que la distribución de la tensión mecánica es más desventajosa en dientes inmaduros y maduros con tejido reparativo (como el formado después de la endodoncia regenerativa), que en dientes desarrollados con dentina. Se llevaron a cabo estudios en material cadavérico para analizar métodos de ampliación del foramen apical de dientes maduros y un estudio experimental para evaluar a efectividad de la terapia en dientes maduros de hurón con forámenes ampliados. Los resultados mostraron que es posible la formación de un tejido conectivo vascularizado en el interior del canal de dientes maduros, pero este tejido ocupó solo el tercio apical. Se realizaron revisiones sistemáticas relativas al efecto de concentrados de plaquetas en la terapia, y se concluyó que si bien los dientes tratados con concentrados de plaquetas mostraron mejores resultados clínicos, el tejido neoformado es tejido reparativo, es decir, carente de odontoblastos y dentina. Se llevó a cabo un estudio in vitro para aislar y cultivar odontoblastos y se concluyó que no es posible mantener odontoblastos vitales in vitro, probablemente debido a la disrupción del proceso odontoblástico durante la aislación. Por último, se realizó experimentos in vitro que buscan evaluar la capacidad de diferenciación odontogénica de las células pluripotentes del amnios, investigación que actualmente está en fase de ejecución.

Les soins pulpaires en denture lactéale sont les soins fréquemment réalisés en odontologie pédiatrique et la réaction pulpaire ainsi que les mécanismes de réparation tissulaire lors d’un traumatisme ne sont pas très bien connus ou investigués. En se référant à la littérature dentaire, on constate que les recherches sont souvent focalisées sur la denture définitive.

Objectifs

1) Etudier l’influence du traitement avec divers matériaux sur la formation dentinaire, la structure tissulaire et le degré d’inflammation.

2) Acquérir des connaissances sur l’interaction à l’interface matériau/tissu.

3) Etudier le rôle de la voie de signalisation Notch (1 et 2) dans le processus de remaniement et réparation du tissu pulpaire en cas de traumatisme.

Matériels et méthodes

Deux types de soins pulpaires, la pulpotomie et le coiffage direct, sont réalisés sur les dents lactéales porcines et les résultats sont étudiés après 3 périodes :7 jours, 21-28 jours et 90 jours.

La pulpotomie :8 matériaux, 10 dents par matériau, 2 matériaux par cochon et par période pour un total de 240 dents.

Le coiffage direct :10 matériaux, 10 dents par matériau, 2 matériaux par cochon et par période pour un total de 300 dents.

Par la suite, différentes techniques ont été utilisées :

1. La microscopie optique :étude des coupes histologiques après coloration.

2. La microscopie électronique à transmission :observer les caractéristiques morphologiques du tissu pulpaire et analyser les structures cellulaires en détail. L’objectif principal de cette recherche était centré sur les biomatériaux pour la période de 21-28 jours afin d’examiner l’interaction entre le biomatériau et le complexe dentino-pulpaire après leur placement.

12

3. La voie de signalisation Notch (1 et 2): investiguer l’intervention éventuelle de cette voie dans le processus de régénération tissulaire par différenciation des cellules pour les deux périodes de 7 et 21-28 jours pour tous les matériaux utilisés.

Résultats

A. Microscopie optique :

1. La pulpotomie :les biomatériaux provoquent moins d’infiltrat de cellules inflammatoires au niveau du tissu pulpaire et favorisent la déposition dentinaire.

2. Le coiffage direct :on obtient les mêmes résultats que dans le cadre de la pulpotomie.

B. Microscopie électronique en transmission :

1. L’induction du tissu calcifié ou la formation de néo-dentine s’est seulement produite au niveau du site de l’exposition après le placement des biomatériaux dans les 2 types du traitement (pulpotomie & coiffage direct). En revanche aucune formation du tissu calcifié n’a été observée dans le parenchyme pulpaire à distance du site de l’exposition.

2. Cet examen montre que les cellules en contact des biomatériaux ou même à proximité de ces derniers présentent un réticulum endoplasmique élargi parallèle à la longueur de la cellule. Des mitochondries, plusieurs appareils de Golgi et des éléments denses sont observés dans le cytoplasme cellulaire.

3. Cet examen a également montré que le MTA et le WPC, considérés par la littérature dentaire comme non-résorbables, sont phagocytés par les cellules histiocytaires.

C. Voie de signalisation de Notch :

Nos recherches n’ont pas montré de marquage concluant pour aucun de matériaux sauf dans le cadre de coiffage direct pour les dents traitées au MTA et Ca(OH)2 pour la période de 7 jours. Par contre, aucun marquage n’est observé après 21-28 jours.
Doctorat en Sciences dentaires
info:eu-repo/semantics/nonPublished

Thesis (M.S.)--West Virginia University, 2000.
Title from document title page. Document formatted into pages; contains vii, 82 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 47-52).

The Dental pulp has remained a diagnostic enigma to the dental surgeon. While some dental pulps would react inadvertently even to the slightest injury, at other times highly resistant pulp tissue has regenerative properties even after extensive damage has been noted. However, most of the time clinicians can make a uniform decision about the status of the dental pulp with the help of clinical signs and symptoms and make a patient-centric treatment plan that can provide pain relief and restore the form and function of the tooth. A distinction needs to be made between acute and chronic inflammatory conditions of the pulp and between the reversibility or irreversibility of the pulpal changes so that appropriate vital or non-vital pulp therapies can be selected. It is also important to distinguish between inflammatory conditions and degenerative conditions of the pulp. While inflammation almost always requires intervention, changes like degenerative calcific changes may require observation and occasional intervention.

Abstract As discussed in previous chapters, bacteria are responsible for both dental caries and periodontal diseases. Extension of these diseases commonly causes infection in the adjacent tissues, notably the pulp, periapical area and oro-facial soft tissues. More rarely, infection may become established in the bone of the jaw to cause osteomyelitis. These infections, which are usually acute and are among the most common seen by dentists, will be covered in this chapter. Inflammation of the pulp (pulpitis) may follow exposure to a range of irritants. These include thermal, mechanical or chemical stimuli, in addition to micro-organisms which are the focus of this chapter. Since the pulp is enclosed within the hard tissues of the tooth, it is unable to expand during the acute inflammatory phase of pulpitis, with a resultant rise in internal pressure. This not only results in severe pain but also impairs the circulation within the inflamed pulp, which may cause pulpal necrosis and subsequent periapical disease. The possible outcomes are illustrated in Fig. 25.1. Whilst the most common cause of pulpal necrosis is dental caries, others include accidental trauma to the tooth, exposure of the pulp during instrumentation and spread of infection from a deep periodontal pocket.

Abstract Endodontology is defined as the study of the form, function and health, injuries to and diseases of the dental pulp and periradicular tissues, their prevention and treatment (International Endodontic Journal, European Society of Endodontology 1998). Endodontics is the practice of this science. The aetiology of the most common diseases of the dental pulp and periradicular tissues is microbial (Kakehashi et al. 1966) and the objective of endodontic treatment is to eliminate microbial irritation of the pulpal and periradicular tissues. Dental caries and its subsequent removal and replacement with restorations and traumatic injuries to the teeth are the most common sources of microbial contamination of the dental pulp and periradicular tissues. Endodontic treatment must be part of holistic care to ensure that oral and general health of the patient is maintained.Undergraduate education in endodontics expects competence to be achieved in practical procedures, involving management of the dental pulp and root canal treatment in both singleand multi-rooted teeth.

Dental caries, as a pervasive and complex global health issue affecting individuals of all ages, is influenced by a multitude of factors. These factors encompass the interplay of demineralization and remineralization processes, dietary and oral hygiene practices, salivary composition and flow, tooth morphology, genetics, fluoride exposure, and environmental and socioeconomic variables. This chapter analyzes three categories of factors that cause dental caries, such as: general, local, and iatrogenic factors. Initially, the genetic predisposition, gender-related hormonal fluctuations, aging, immunological elements, pregnancy-related changes, chronic diseases, hormonal disorders, vitamin levels, and socioeconomic factors are included in general factors that contribute to the susceptibility to dental caries. Moreover, to understand and mitigate caries risk, it is pivotal to analyze local factors such as dental morphology, oral hygiene, and the vital role of saliva. Additionally, premature loss of primary teeth, crowding, orthodontic treatment, dental fillings, and prosthetic dental work can lead to iatrogenic issues affecting oral health. Recognizing the multifaceted nature of dental caries, susceptibility underscores the necessity for comprehensive strategies in oral health care. Therefore, this chapter underlines that proper oral care, preventive measures, and meticulous attention during dental procedures are paramount for maintaining optimal oral health.

Oral disease is one of the most significant global health concerns. Oral diseases have a monetary impact on people in developing countries. Disease can occur at any age and across a variety of demographic and socioeconomic conditions. Dental caries is a chronic microbial disease caused by a variety of factors, including the production of acid by bacteria via carbohydrate fermentation, which causes demineralization of tooth enamel, eventually leading to the loss of tooth structures and pulp infection. Caries is caused by an imbalance between tooth minerals and dental biofilms, which can develop over time in many people. Symptoms of dental caries begin with tooth pain and cavities and can lead to tooth loss. To prevent disease and maintain good oral health conditions, caries risk assessment is critical for controlling the progress of dental caries. Risk assessment is done by performing caries activity tests. Knowing the etiological factors associated with dental caries is important for clinicians and patients to prevent the disease from developing or halt its development and complications.

Dental pulp stem cells (DPSCs) are a special mesenchymal stem cell (MSC) type. These cells can be isolated from the dental pulp (DP) of deciduous, adult, and wisdom teeth. Stem cells from milk/baby teeth fall naturally, representing an advantageous source of young stem cells. These cells are less studied than MSCs from bone marrow, adipose tissue, and umbilical cord. MSCs from these sources are currently widely used in clinical studies. However, obtaining significant quantities of DPSCs from one donor is still challenging, thus limiting their systemic application in patients, which requires doses starting from 5 × 105 per kg of weight and higher. In this chapter, we would like to share our experience of more than 20 years in the isolation and scaling up of DPSC from deciduous teeth. We will also provide information about their in vitro growth, differentiation, and therapeutic potential observed in animal models that mimic human diseases or injuries in preclinical studies. Finally, we will discuss our experience of DPSC production under good manufacturing practice conditions and their use in regulated clinical studies in Brazil for Huntington’s disease.