Dental Biologics for Underserved Populations

描述(由申请者提供)：口腔保健的不平等是健康不平等的一个严重未得到解决的领域。相当大的人口，主要是那些在社会经济上处于不利地位的人，以及包括西班牙裔、非裔美国人和美洲原住民在内的族裔群体，获得口腔保健的机会令人震惊。牙髓是牙齿中央核心的血管化结缔组织，维持牙齿的动态平衡。 一个在生物上可以存活的器官。当龋齿或创伤涉及牙髓时，需要进行牙髓治疗。在不可逆性牙髓炎中，牙医或牙髓医生拔除牙髓，并用生物惰性材料堵塞预备好的根管。仅在美国，每年大约有1600万例牙髓治疗手术。然而，社会经济上处于不利地位的人群很少有机会获得根管治疗，而且经常需要拔除受感染的牙齿。虽然根管治疗是成功的牙科治疗之一，但并发症在文献中已被反复记录。由于冠状渗漏或未发现的副管所引起的继发感染并不少见，需要再次治疗。在根管治疗过程中，大量的牙齿结构被移除，导致牙齿折断的发生率增加。根管治疗的牙齿没有神经支配和牙髓感觉， 因此被剥夺了检测二次感染的能力。我们的初步数据首次表明，在活体内，经过根管治疗的人的牙齿可以重新细胞化和重新血运。因此，SBIR/第一阶段建议的总体目标是开发基于生物学的牙髓再生方法，其成本大大低于当前的根管治疗，并且易于获得服务不足的人群，他们目前几乎没有机会获得传统的根管治疗。 公共卫生相关性：这个SBIR/第一阶段项目将通过开发牙髓再生的新疗法来解决口腔保健方面的巨大差距。总计 仅在美国，每年就有大约1600万例牙髓手术。然而，目前的根管治疗是一种昂贵的牙科治疗，社会经济弱势群体获得的机会少得令人震惊，但会导致牙髓组织失活。我们已经生成了初步数据，证明在人类牙齿中可以实现牙髓再生，而成本只有目前根管治疗的一小部分。我们建议利用SBIR机制来开发基于生物的、可再生的根管疗法，这种疗法是负担得起的，也是服务不足的人群可以获得的。

DESCRIPTION (provided by applicant): Disparities of oral health care are a significantly under-addressed area of health disparities. A substantial population, primarily those who are socioeconomically disadvantaged and of ethnic groups including Hispanics, African Americans and Native Americans, have alarmingly poor access to oral health care. Dental pulp is vascularized connective tissue in the central core of a tooth, and maintains homeostasis of the tooth as a biologically viable organ. When caries or trauma involves dental pulp, endodontic therapies are indicated. In irreversible pulpitis, the dentist or endodontist extirpates dental pulp, and obturates the instrumented root canal with bioinert materials. A total of approximately 16 million endodontic procedures are performed each year in the United States alone. However, individuals of socioeconomically disadvantaged populations have little access to root canal therapy, and frequently have their infected teeth extracted. Whereas root canal therapy is one of the successful dental treatments, complications have been repeatedly documented in the literature. Secondary infections due to coronal leakage or undetected accessory canals are not uncommon, and require re-treatment. A substantial amount of tooth structure is removed during root canal treatment, leading to increased incidences of tooth fracture. Root canal treated teeth are devoid of innervation and pulpal sensation, and thus are deprived of the ability to detect secondary infections. Our preliminary data demonstrate, for the first time, that endodontically treated human teeth are recellularized and revascularized in vivo. Accordingly, the overall goal of this SBIR/Phase-I proposal is to develop biologically based approaches for dental pulp regeneration at a cost that is substantially less than the current root canal therapy and readily accessible by underserved populations who currently have little access to conventional root canal therapy. PUBLIC HEALTH RELEVANCE: This SBIR/Phase I project will address a substantial disparity in oral health care by developing novel therapies for dental pulp regeneration. A total of approximately 16 million endodontic procedures are performed each year in the United States alone. However, current root canal therapy is an expensive dental treatment with alarmingly poor access by socioeconomically disadvantaged populations, and yet leads to de-vitalized pulp tissue. We have generated preliminary data to demonstrate that dental pulp regeneration can be realized in human teeth at a fraction of the cost of current root canal therapy. We propose to take advantage of the SBIR mechanism to develop biologically based, regenerative root canal therapy that is affordable and accessible by underserved populations.