Desmocare - Handling the Dark Side of Dental Materials

Evidence note: Laboratory studies show that some incompletely polymerised dental resin monomers can affect cells through oxidative-stress pathways. This does not establish that a specific antioxidant product prevents clinical harm. Product claims should be evaluated against independent human clinical evidence.

Today, dental treatments provide lasting solutions to dental problems. The dentist has multiple options in terms of materials not only to reconstruct broken teeth, but also to implant an artificial fixer in the oral cavity. in case of no teeth. However, use of various dental materials and combinations used in the same oral cavity can be detrimental to successful treatments. Use of materials such as Desmocare can help in handling these deleterious effects.

Detrimental Effects of Dental Materials

The most important focus of clinicians is to make treatment solutions last for several years. But the reactions to the materials used for these solutions, on the oral tissues in the oral environment and countering their possible deleterious effects needs extensive research and watchful observations. Through dental procedures and environment, periodontal tissues are exposed to many types of reactive oxygen species (ROS). If not attended to regularly or if oral hygiene is compromised, it could lead to various oral pathological conditions like

• ulcers
• gingivitis
• ulcerative/desquamative gingivitis
• mucositis
• periodontitis
• peri-implant mucositis and
• peri-implantitis.

They are all a result of increased oxidative stress in the oral cavity. Compromised daily oral hygiene regimen and regular professional hygiene care complicates the situation further.

Oxidative Stress - The Silent Striker

The physiologic and pathologic changes in the human body depend on free radical (FR) and reactive oxygen species (ROS) interactions to maintain normal cellular activities. In aerobic organisms, the imbalance between ROS generation and antioxidant levels leads to increased oxidative stress and cellular degeneration. Various conditions which increase oxidative stress in the oral cavity can be:

1. Diets high in fat, sugar and processed foods.
2. Exposure to radiation.
3. Smoking cigarettes or other tobacco products
4. Alcohol consumption.
5. Systemic diseases such as cardiovascular, pancreatic, gastric, and liver diseases.
6. Sources of free radical insults in dental therapy

Possible interactions due to various dental materials used, in conjunction with plaque buildup in oral cavity, and other local factors/ oral habits can be deleterious to the oral health over time. In dentistry, certain components in many commonly used dental materials may form free radicals:

• Bleaching agents
• Composite fillings
• Dental cements
• Ceramic restorations
• Metals in restorations such as in fillings, braces, bridges and other prosthodontic restorations
• Titanium dental implants

The use of these components or materials, unfortunately, cannot be completely obliterated from dental practice. However, preventive measures and even therapeutic modalities can be put in place, which help reduce or negate the radical formation caused by these materials.

Role of Oxidative Stress in Periodontitis

Bacterial plaque is the most important substrate in periodontal disease development. A study of dental plaque bacteria has implicated its role in inducing "oxygen shock" to activate free radicals and the collagen-destroying enzymes. The process of collagen matrix degradation affects not only the amount of bone destruction and rate of inflammation but also the free radical damage, mechanical trauma, and tissue destruction. Dental products, as well as dietary and environmental compounds, are among the many sources of ROS. In particular, tobacco smoking promotes ROS release, resulting in heightened oxidative damage to periodontal tissues. This oxidative stress is involved in the progression of periodontitis, a chronic inflammatory disease of the periodontal tissue, caused by disturbance in the regulation of the host inflammatory in response to bacterial load.

Role of Oxidative Stress in Dental Implantology

Oxidative stress leads to compromised osseointegration and peri implant disease. Effect of Oxidative stress on dental implants happens in two ways, either just after implant placement or due to peri-implant disease.

• After Implant Placement, micro fractures and compression damages the titanium oxide (TiO2) layer which leads to corrosion of titanium particles and increase the inflammation of reactive oxidative stress (ROS) -free radicals which damage the endothelial cells leading to absence of osseointegration.
• Peri-implant disease, primary bacteria adhesion join to the glycoprotein layer leads to formation of bacterial biofilm, these phenotypical changes occur at the bacterial colony and late colonizers produce lactic acid, reduces the pH leads to Peri-implantitis.

Solution to Oxidative Stress - Antioxidants

Antioxidants are substances that can prevent or slow cell damage by neutralizing free radicals, unstable molecules that can contribute to aging and various diseases. They can counter the formation of free radicals and prevent free radical damage by donating electrons. They are found in many foods, particularly fruits and vegetables, and can also be taken as supplements. Antioxidants are of various forms, which we have all heard of, such as:

• Vitamins: Vitamin C, Vitamin E
• Carotenoids: Beta-carotene, lycopene, lutein, zeaxanthin
• Minerals: Selenium, manganese
• Other compounds: Polyphenols, flavonoids, glutathione, resveratrol

Certain foods are rich in antioxidants such as:

• Fruits: Berries, citrus fruits, tomatoes, etc
• Vegetables: Dark leafy greens, kale, artichokes, etc
• Other: Dark chocolate, coffee, beans, nuts

The key to reduce oxidative stress due to dental materials, is to incorporate antioxidants along with antibacterials in the hygiene therapies. Antioxidants cause the degradation of mineral deposits, making them water-soluble. Antioxidants can prevent the formation of dental stains that occur from oxidation of both organic and inorganic compounds.

Desmocare - A Novel Product

Dental products such as Desmocare provide total solutions to oxidative stresses in the oral cavity. Desmocare mouth wash, powered by desmotite, is an innovative long-term solution for maintaining optimal health around dental implants. It works by reducing oxidative stress, thus enhancing the immune response, and at the same time acts as a mild natural antiseptic. Desmocare mouthwash contains Guava leaf extract 5%, Sodium Perborate monohydrate 0.1% and Honey 0.1%. Desmocare is developed in collaboration with Dr Ratnadeep Patil, a pioneering Indian implantologist with 35 years of experience. Desmocare supports implant success rate by its powerful antioxidant protection, targeted anti-inflammatory action and broad-spectrum antimicrobial action. Desmocare reduces the risk of mucositis and peri-implant disease by promoting peri implant health and its crucial for implant longevity. By focusing on antioxidant effects, in addition to antibacterial effects, it is remarkably successful in reducing the oxidative damage to oral tissues. Its ingredients, and their functions include:

• Sodium perborate- Reduction in oxidative stress, activates honey for antibacterial effect
• Guava leaf extract- Additive anti-oxidant, savenges all the free radicles due oxidative stress and helps in reduction of stress
• Honey- Antibacterial, on degeneration gives out hydrogen peroxide which is nourishing to the cells

Use of Desmocare can be preventive or therapeutic. Incorporation of such antioxidant therapies in clinical practice must be considered for ensuring the overall health and comfort for the patient.

Do not treat a presumed material reaction without confirming the problem

Oral burning, lichenoid change, taste disturbance or discomfort has many potential causes. Temporal association with a restoration does not prove allergy, toxicity, galvanism or oxidative injury. Assessment should document onset, distribution, material exposure, medicines, mucosal findings and alternative diagnoses before removing restorations or recommending adjunctive products.

For interdisciplinary referral, read medical specialists and oral health. Ethical product recommendation is discussed in implant-practice ethics. Consent to material alternatives is covered in informed consent.

Frequently asked questions

Does discomfort prove a dental material allergy?

No. Allergy is one of several possible explanations and requires diagnosis.

Should restorations be removed as a diagnostic test?

Not routinely. Removal is irreversible and should follow a reasoned diagnosis and consent.

How should a branded adjunct be discussed?

State evidence quality, alternatives, risks, costs and any commercial relationship transparently.