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STEM CELLS IN DENTISTRY


Dionisios Laghios Student of European Dental School of Madrid

ABSTRACT


BACKGROUND
Stem cells are a unique kind of cells that are linked with the origin of life and the development of each living being. Modern advancements of biology and medicine enable us to know in details their main characteristics, and their potentials. Nowadays, stem cells play a significant role in the development of new medical therapies and can be used to face medical challenges that could never have been solved before, even in the field of dentistry.

METHODS
A cross-sectional study was advanced in a sample population composed of European dentists (Greeks, Italians and French). The dentists were subjected to a questionnaire regarding the use of stem cells in the framework of dental therapies. Their opinions, will of personal investment and knowledge on this therapy were the main points our questionnaire tried to find out. Software such as Excel, Pages were used to analyze the data and display the results of our questionnaires.

RESULTS
The sample population had shown a positive opinion regarding this new cure, because the possibilities of providing a long lasting benefits to the patients as never before was possible. It was found that non-medical populations aren’t really aware of this therapy, proving the novelty of the process.

CONCLUSION
European dentists may have a strong positive opinion on the stem cells therapy amongst the dental field.

INTRODUCTION STUDYING OF THE STEM CELLS THERAPY

NATURE AND PROPERTIES OF STEM CELLS
In order to understand what’s the matter with stem cells, it is needed to go back to the very origin of life. After the fecundation, the individual is in an unicellular state, it’s only composed of the zygote (blastocyst), result of the fusion of the nucleus of the spermatozoid and the an ovule. The blastocyst, when developed, will give birth to any other kind of cells present in our body. It is, therefore, a totipotent cell. However, it first divides into several cells that can only differentiate, later, in defining group of cells, like muscular, neuronal, cartilaginous or bony ones, depending on what kind of signal they are going to receive. They are called pluripotent cell and commonly stem cells. 1 Human embryonic stem cells (hES) are responsible for the forming of our body. They are found in the mesenchyme connective tissue, specific to embryos and in the umbilical cord, Wharton’s jelly. They slowly disappear as the body grows, even if some stem cells remain present, like the osteogenic stem cells located near bones, which differentiate into the bone cells, the osteocytes. They are then, responsible for body repairs, through time.2,3 It can then be easily deduced that, isolated, they could be of paramount importance for artificial tissue repair, which is the replacement of worn-out, damaged, or dead cells. Because of their undifferentiated state, the main goal of the stem cells research is to extract, to store them and master how to send them the right signals, in order that they can differentiate in the needed kind of cells, and then re inject them in the patient’s body. Thus, one of the main challenges is to properly extract and conserve them, in order to exploit their stunning properties.
A glimpse of the unique and gripping property of stem cells. The multilineage differentiation.


As dentistry has the goal of healing oral diseases and improve the esthetics of the oral cavity, different paths have been followed. In order to achieve this final goal, dentistry is trying to achieve intermediary objectives one of them is the research and development of new medical techniques as the use of stem cells in the framework on a therapy. To make it possible, it is necessary to analyze and understand the opinions that the dentists have about this cure. This is a new therapy that has extremely positive outcomes and several medical applications 6,15. It can be then assumed that the majority of dentists would have a positive opinion regarding this new field. As stem cells can open a path of curing several diseases that could not be cured in the past, this research may state that majorities of dentist are in favor of this treatment.

MATERIAL AND METHODS
During the making of the research, different methods were applied.

Composition of a sample population
A sample population was composed of Italian, Greeks and French dentists. The sample population was chosen because of their professional experience, and awareness of current medical therapies.

Collection of data
In order for the research to take place, different questions were asked to the subjects, which are included in the questionnaire. The questionnaire was designed in order to get the opinion of the European dentists regarding the use of stem cells applied in medical therapy. It was first submitted to the UEM M1A class during the pre-pilot study. They recommended the research team to increase the quality of the layout and general readability, for the pilot study. Not any single comments regarding the main points of our questionnaire were received during the pilot study. The handed questionnaire is attached as Annex I.

Tabulation of data
Software such as Excel were used in order to analyse the previously collected data with the purpose of making the conclusions as readable and understandable as possible for the readers.

RESULTS

AWARENESS AMONGST DENTISTS
Regarding the use of stem cells in dentistry, the 90% of the sample population has heard of the Stem Cells therapy before the beginning of the study, whereas 10% of it had never heard about the Stem cells therapy before participating to our study. (Fig 1.)
Fig.1 Awareness of the sampled dentists regarding the Stem cells therapy

When the sample population was asked how they became aware of this therapy, the 10% of it answered that they acknowledged it at the university, the 10% during later studies, the other 40% at a congress, and a 30% in other ways. (Data not shown)

AWARENESS AMONGST PATIENTS
Regarding the question if any patient had ever asked the sampled dentists about this cure, the vast majority of 90% answered that it never happened and only the 10% answered that they have been asked about it before. (Data not shown)

A STILL BLOOMING PROCESS
When the sample population was asked when they thought that this cure would become viral, the 70% of it answered only when the technology will be more developed, 20% when the people will become we're aware of this technique and 10% assumed it will never be developed. (Fig.2)
Fig.2 Opinions of the sampled dentists regarding the potential spread of the Stem cells therapy.

When asked the sampled dentists about the time when this therapy was first developed, the 50% of it thought it was two years ago and the other 50% thought it was more than 2 years ago. (Data not shown)

ETHICS, SAFETY AND RELIABIALITY
When the sample population was asked whether it will create any controversy or not, only the 10% answered that it would create some and the vast majority of the population answered that it won’t create controversies. (Fig. 3)

Fig.3 Opinions of the sampled dentists regarding whether it will generate any potential controversy or not.

Being asked about the safety of the procedure, the 30% thinks that is safe, the 40% that will not be safe and the 30% answered other. (Fig. 4)


Fig.4 Opinions of the sampled dentists regarding the practical safety of the Stem cells therapy.

Asking about the safety of the procedure the 70% of the sample population thinks that is safe, the 20% that will not be safe and the 10% answered other. (Fig. 5)


Fig.5 Opinions of the sampled dentists regarding the medical reliability of the studied therapy.

TECHNICAL ASPECT
All of the sample population insisted over the fact that disposing of human tissues, low differentiated ones was essential for the therapy. Moreover, some of the dentists insisted over the fact that we would need very specialized tools, such as centrifuge machines. All the physicians have been of the same idea that stem cells will be used to cure untreatable diseases till know, and in order to replace the artificial prosthesis by living, and always accepted by the naturally synthetized ones. Regarding the economic aspect of this therapy, the great majority of the sample population (80%) thinks that it will cost more than 1000€, and only the 20% remaining thinks of a price less expensive than this amount. As for the question if whether it will be supported or not by social security, 40% of the sample population thought that this therapy will be supported, whereas 60% were convinced of the opposite.

PERSONAL INVESTMENT IN THE STEM CELLS THERAPY

80% of the sample population ever thought of accomplishing this therapy later, whereas 20% were in favour of the opposite. (Fig.6)

Fig.6 Opinions of the sampled dentists regarding their will to accomplish or not accomplish the Stem cells therapy later.

Regarding what kind of studies will be necessary to be able to perform this therapy, the great majority of the sample population (70%) said that a Master would be needed and the 30% a PhD. (Data not shown) 10% of the sample population doesn’t support the Stem cells therapy whereas 90% does support it. (Fig 7.)

Fig.7 Opinions of the sampled dentists regarding their critical position regarding the Stem cells therapy.

DISCUSSION

AWARENESS AMONGST DENTISTS
Most of the dentists were aware of the stem cells therapy, whereas only a small remaining proportion of them was not aware of it before the beginning of the study. Among the remaining small sample population that was not aware of the therapy, the individuals were closer to retirement. It might be due to the fact that they used work many years, performing specific given therapies. Furthermore, the stem cells therapy is not fully developed nor widely acknowledged in Europe, meaning that they will probably be in retirement when it will be vastly used by dentists. As shown by the results, the different dentists have had information from a very wide range of primary and secondary sources of information, probably as a result of the poor knowledge that we generally have around this really new topic. Most of them in particularly had their first contact with this topic only after many years through congresses and other channels of information spreading as mass media, meaning that it wants to draw more and more the attention of dentists over it.

AWARENESS AMONGST PATIENTS
As the dentists has asked rarely about stem cell therapy, such data shows how new the cure is. It may also constitute a proof that there is not enough media coverage. The little that there is not being useful for both potential patients and dentist professional expansion and advance of medicine, as a significant part of the sample dentists thinks that the therapy will become viral when people are more aware of it.

A STILL BLOOMING PROCESS
The majority of the dentists from the sample population assumes that the Stem cells therapy will become viral the technology is more developed. It makes fully sense, since the dentist is first and foremost a doctor. He’s constantly researching new scientifically processes and methods that are only meant in order to promote the welfare of the patient when he is healthy, and restore its health when it is lost. Moreover, it’s easy to assess that scientifically sound therapies can only be made through sharply developed instruments and equipment. Maybe most of the asked dentists agree with this way of thinking, explaining the high prevalence of this answer. Then, a less numerous, but still significant part of the dentists stated that it will be developed when potential patients are more aware of this therapy. We can presume that people are most likely to try a certain kind of medicine if they know it worked well among other people they know, or they have heard about. Treatments that are provided with rich media coverage are most likely to be tried or be accepted by people. Another part of the asked dentists assume that there will be another factor that will promote the Stem Cells therapy. Maybe it could be a governmental announcement or an acknowledged medical proof of a very efficient treatment, in an isolated case. Not any of the asked dentists assumed that it would become viral when the risks are well known. Given the fact that the feedbacks regarding the use of the Stem Cells therapy were averagely good, we can guess that the sampled dentists don’t want the Stem cells therapy to be acknowledged as a risk-providing therapy, testifying of a certain will from dentists to promote this therapy, even if some believe in the existence of risks. It can be assumed assess that most of the European dentists weren’t so much invested in the Stem cells therapy, even though having already heard of it for most of them. It proves another time how new this process is.

ETHICS, SAFETY AND RELIABIALITY
A small part of the sampled dentists believe in the existence of controversies that could be encountered when developing further the Stem cells therapy. When asked for precision, this part, represented by a single dentist informed the research team of a problem related to ethics. According to this dentist, extracting stem cells from the body of patients in order to make them develop (multilineage differentiation) in laboratory can be considered wrong, unethical, because it goes against most religious and some social beliefs, stating that the human body must not be used for such experiment of this span. However, the other, most numerous, part of the sampled dentist didn’t think of any potential controversy regarding this theory. We are then confronted to a problem in the research, where social and religious thinking regarding this therapy cannot be studied at a European level. The Stem cells therapy is a brand new medical pathway, and we don’t know yet if is completely safe. As a result that the therapy is still at its primitive practical level, the results are heterogeneous and quite equally divided. It is moreover merely because we do not know how the therapy is going to be developed. The opinion of the sample population depicted in the graph reflects the thinking. The information that wasn’t enough to state if this revolutionary kind of cure has or could have negative effects in the future for the patients’ health. Given the fact that this therapy is at a nearly practical level and not commonly spread around Europe, we can assess that this graph is giving the research team a first draft of the scientific opinion of dentists over the Stem cells therapy. Even though most of the sampled dentists declared themselves as supporters of the Stem cells therapy, opinions are diverging regarding specific aspects of the stem cells therapy, granting the research team the information that the efficiently of Stem cells therapy is already discussed among the dental profession field. Most of the sampled dentists think of the therapy as a reliable care in a long term for potential patients, granting the Stem cells therapy a significant trustworthy step ahead in the medical and dental domain. Some of the dentists, however, still doubt its efficiency in a very long term, as we can see in the graph, granting the research team the conclusion that the stem cells therapy, even supported by professionals would not be considered as a cornerstone in the medical domain.

TECHNICAL ASPECT
As there is more information about the abilities of this new cure as it has hypothesized many years ago we can see that the vast majority knows specifically were we would be able to apply this cure in the oral cavity as cure to what until now was approached with artificial prosthetics as there was nothing that could substitute them. It can be assumed that there is still really little knowledge around this topic since the different dentists know only the fundamental materials that probably will be used in this cure the only that we're a little bit more specific we could assume that are younger and have more knowledge regarding this topic. Most of the sampled dentists think of the therapy costing more than 1000 euros. This can testify and grant the research team the confirmation that this therapy could be requiring very sharp and advanced materials, which could be very costly for the professional. Also it can be assumed that some dentists believe that the therapy will be supported by social security because they think this therapy as very helpful, and providing many advantages comparing other therapies, and then, making it a very important piece of modern medicine. However, most of the sampled dentists no thinking it will be ensured by social security can make the research team think, again, about the final price of this therapy. Sometimes, a too expensive treatment might no be ensured by Social security, or generate controversies within the ministries and governmental institutions, as it is the case with the Solvadi7 , in France. This can also testify of a link with ethics. We can guess that if it were regarded as unethical by a majority of dentists and professionals (which is not the case in the study) then governments could ban this therapy and thus, not allow it to be ensured by Social security.

PERSONAL INVESTMENT IN THE STEM CELLS THERAPY
Stem cell therapies in dentistry are both promising and challenging. That’s why the prevalence of dentist wanting accomplishing this therapy is very high. Moreover it will be very profitable for the dentist, for the sake of their profession. Providing the sharpest and finest care are not only very well for the dentist’s reputation and acknowledgment, but also a basic standard in the profession of physician. The dentists that choose not to use the therapy probably believe that the risk that they take using this therapy is not worth for the results, not providing enough profitable outcomes for a potential patient. This is again related to a medical process still being in stages of development. Most of the dentists assume that you only need a level of study equal to a master in order to perform such a therapy. This information testifies that the Stem cells therapy, although being a very sharply developed process, is still accessible for most of the dental professional. This information can make the research team think that its spread will then be eased in future times Most of the dentists from the sample population are favourable of the blooming of the Stem Cells therapy. Given the fact that the Stem cells therapy is just only at its nearly practical level and that it is not a common therapy, such as chemotherapy for instance, it testifies that the stem cells therapy will probably widely accepted within the dental field. However, a part of the sample population is openly opposed to the Stem cells therapy. It could be because of some dentists’ fear of risks, or probably generated controversies.

CONCLUSION
The sample population, overall, expresses favourable opinions regarding the blossom of the stem cells therapy, which a great prevalence was previously already aware about it. Most of them genuinely expressed their enthusiasm, and their will to accomplish such a therapy in the future. Also we realized that opinions were divided, or several dentists were not really sure of their state of mind regarding the Stem cells field, when talking about specific applications. This is why by the way why there is so little reference in the research. This not uniformed knowledge was observed because the sample consisted of general dentists, and did not feature anyone that had real specify knowledge regarding this field. However, most of them genuinely expressed their enthusiasm, and their will to accomplish such a therapy in the future. As a conclusion, the main finding of the research was that there was a positive view regarding this new research, but there still very little knowledge this is caused by the primary stage of research around stem cells. It can be assessed, with a low risk of error, that the hypothesis is true. European dentists do view the Stem cells therapy in a favourable light. Thus, confirming the alternate hypothesis depicted in the introduction.

Adam SADONE
Vassilios DIMOGLOU
Dionisios LAGHIOS