Stem Cells from Human Exfoliated Deciduous Teeth: A Growing Literature

Adult stem cells research has been considered the most advanced sort of medical-scientific research, particularly stem cells from human exfoliated deciduous teeth (SHED), which represent an immature stem cell population. The purpose of this review is to describe the current knowledge concerning SHED from full-text scientific publications from 2003 to 2015, available in English language and based on the keyword and/or abbreviations 'stem cells from human exfoliated deciduous teeth (SHED)', and individually presented as to the properties of SHED, immunomodulatory properties of SHED and stem cell banking. In summary, these cell populations are easily accessible by noninvasive procedures and can be isolated, cultured and expanded in vitro, successfully differentiated in vitro and in vivo into odontoblasts, osteoblasts, chondrocytes, adipocytes and neural cells, and present low immune reactions or rejection following SHED transplantation. Furthermore, SHED are able to remain undifferentiated and stable after long-term cryopreservation. In conclusion, the high proliferative capacity, easy access, multilineage differentiation capacity, noninvasiveness and few ethical concerns make stem cells from human exfoliated deciduous teeth the most valuable source of stem cells for tissue engineering and cell-based regenerative medicine therapies.

Influence of contact points on the performance of caries detection methods in approximal surfaces of primary molars: an in vivo study

This in vivo study aimed to evaluate the influence of contact points on the approximal caries detection in primary molars, by comparing the performance of the DIAGNOdent pen and visual-tactile examination after tooth separation to bitewing radiography (BW). A total of 112 children were examined and 33 children were selected. In three periods (a, b, and c), 209 approximal surfaces were examined: (a) examiner 1 performed visual-tactile examination using the Nyvad criteria (EX1); examiner 2 used DIAGNOdent pen (LF1) and took BW; (b) 1 week later, after tooth separation, examiner 1 performed the second visual-tactile examination (EX2) and examiner 2 used DIAGNOdent again (LF2); (c) after tooth exfoliation, surfaces were directly examined using DIAGNOdent (LF3). Teeth were examined by computed microtomography as a reference standard. Analyses were based on diagnostic thresholds: D1: D 0 = health, D 1 –D 4 = disease; D2: D 0 , D 1 = health, D 2 –D 4 = disease; D3: D 0 –D 2 = health, D 3 , D 4 = disease. At D1, the highest sensitivity/specificity were observed for EX1 (1.00)/LF3 (0.68), respectively. At D2, the highest sensitivity/ specificity were observed for LF3 (0.69)/BW (1.00), respectively. At D3, the highest sensitivity/specificity were observed for LF3 (0.78)/EX1, EX2 and BW (1.00). EX1 showed higher accuracy values than LF1, and EX2 showed similar values to LF2. We concluded that the visual-tactile examination showed better results in detecting sound surfaces and approximal caries lesions without tooth separation. However, the effectiveness of approximal caries lesion detection of both methods was increased by the absence of contact points. Therefore, regardless of the method of detection, orthodontic separating elastics should be used as a complementary tool for the diagnosis of approximal noncavitated lesions in primary molars.

SHED: stem cells from human exfoliated deciduous teeth

To isolate high-quality human postnatal stem cells from accessible resources is an important goal for stem-cell research. In this study we found that exfoliated human deciduous tooth contains multipotent stem cells [stem cells from human exfoliated deciduous teeth (SHED)]. SHED were identified to be a population of highly proliferative, clonogenic cells capable of differentiating into a variety of cell types including neural cells, adipocytes, and odontoblasts. After in vivo transplantation, SHED were found to be able to induce bone formation, generate dentin, and survive in mouse brain along with expression of neural markers. Here we show that a naturally exfoliated human organ contains a population of stem cells that are completely different from previously identified stem cells. SHED are not only derived from a very accessible tissue resource but are also capable of providing enough cells for potential clinical application. Thus, exfoliated teeth may be an unexpected unique resource for stem-cell therapies including autologous stem-cell transplantation and tissue engineering.

Histological investigation of physiologically resorbing primary teeth using Ag-NOR staining method

OBJECTIVE

The aim of this study was to investigate pulpal tissue of primary teeth in early and late stages of physiological resorption by means of silver-binding nucleolar organizer region (Ag-NOR) staining.

STUDY DESIGN

Ten primary teeth in early, ten in the late stage of resorption and five sound premolar teeth pulps as the control group were investigated by means of silver-binding nucleolar organizer region (Ag-NOR) staining.

RESULTS

The mean number of Ag-NOR's per nucleus increased with the continuing of the resorption process. The difference in the mean number of Ag-NORs was statistically significant both in the early and late stage of resorption compared with controls (P > 0.001). In the early stage of resorption calcific plates in the apical part of the pulps were observed. Odontoclasts, as well as inflammatory cells, were observed in the late stages of resorption.

CONCLUSIONS

The increase in the mean number of Ag-NORs per nucleus with the progression of the resorption process in primary teeth suggests that metabolic cell activity in the early stages of resorption is enhanced and increased with the continuing of the process, thus showing the importance of the pulp tissue in the resorption process.

A histological study of root-resected and root-transected rat incisors when eruption ceases, shortly before they are exfoliated from the socket

Resection of the odontogenic region or root transection of normal (impeded) rat lower incisors showed that eruption ceased from 1 to 13 weeks when the base of the resected teeth (87.5%) or of the distal segment of the transected ones (86%) reached the alveolar-crest region. When the operated teeth reached the crestal region, the enamel-related periodontal tissues were absent and the periodontal ligament (PDL) was the only periodontal tissue that remained. The PDL of the crestal region may be considered as mature PDL, showing a length of approx. 5-6 6 mm at the mesial face of the tooth, 4-5 mm at lingual face and 1 mm at distal face; from these limits towards the apical end of the socket the PDL becomes gradually immature. The mature PDL seems not to have a role in the process of tooth eruption. Several factors can be suggested to explain the more frequent retention, at the crestal region of the socket, of impeded rather than unimpeded incisors submitted to the same procedures. The connective tissue that develops between the base of the tooth and the bone that fills the alveolus may have more time to organize itself in impeded than in unimpeded teeth, which erupt at a faster rate; this tissue could support and retain the impeded operated teeth longer than the unimpeded ones. The decrease in the mechanical properties of the PDL in the unimpeded condition may ease the traumatic effects and lead to exfoliation. Eruption might be stopped by the increase in occlusal forces, per unit area of root surface, as the root becomes shorter; this effect is likely to be greater in impeded than unimpeded teeth.

Loss of deciduous teeth and germs of permanent incisors in a 4-year-old child. An atypic prepubertal periodontitis? A clinical, microbiological, immunological and ultrastructural study

A 4-year-old child was referred, in April 1988, to Rennes Dental School (France) for deciduous tooth mobility with premature loss of 4 deciduous teeth and germs of 2 permanent incisors. Microbiological examinations by culture revealed the presence of the periodontal pathogen Actinobacillus actinomycetemcomitans. Immunofluorescence of plaque samples revealed the presence of Porphyromonas gingivalis that had not been isolated by culture. Neutrophil functions were within normal ranges. Transmission electron microscopy of gingiva showed a disorganised epithelium. The connective tissue was infiltrated by inflammatory cells. The basement membranes were normal, but the connective tissue-epithelium interface was mainly composed of short rete pegs. Scanning electron microscopy of extracted deciduous teeth revealed lack of cementum, lacunae in the cementum and lack of fibrillar insertion on the middle part of the root. Skin lesions, mainly situated on face, were observed. Treatment was by extraction of mobile deciduous teeth combined with 3-week courses of metronidazole. Clinical and microbiological follow-up was continued over a 7-year period. No periodontal lesions have been detected since eruption of the permanent teeth. The present subgingival and lingual microflora (December 1995) is composed of bacteria associated with periodontal health. However, the future appearance of a hitherto undetected systemic disease is still possible.

Dentinal dysplasia type I: review of the literature and report of a family

A family is reported with dentinal dysplasia type I affecting both dentitions. Presenting features included unusual mobility of the teeth, followed by early exfoliation; normal clinical shape of the crowns of the teeth, but with an amber color without any sign of attrition or abnormal loss of enamel. Radiographic findings showed pulp-chamber and root-canal obliteration, poor root formation, radiolucent linear appearance of the pulp chamber parallel to the cementoenamel junction and frequent periapical radiolucencies. Histological studies have reported large masses of calcified tubular dentin, atypical osteodentin, and also true denticle.

Spontaneous exfoliation of teeth following severe elemental mercury poisoning: case report and histological investigation for mechanism

BACKGROUND

Although the spontaneous exfoliation of teeth and breakdown of oral tissues from severe mercury intoxication have been noted for over a century, there are no published reports investigating the mechanisms of these phenomena. Severe mercury poisoning is rare in modern times, but it does occur. We present a case report and a histopathologic investigation into the mechanism of the associated tooth loss.

METHODS

An exfoliated tooth and periodontal and gingival tissues were obtained from a 15-month-old patient who had been severely intoxicated with elemental mercury over a period of months and hospitalized for severe neurologic and renal effects. The tissues were examined both by routine hematoxylin and eosin stain and by autometallography specific for mercury. For comparison, control tissue from an age-matched subject was examined with the autometallography technique.

RESULTS

Under light microscopy, the gingival tissue showed evidence of moderate to severe acute and chronic inflammation. The tooth pulp tissue showed evidence of moderate vascular dilatation and congestion, and it was infiltrated by many neutrophils. The autometallographic sections showed intense accumulations of mercury in the soft tissues of the mercury-exposed subject, but not in the tissues of the control subject. The deposits were primarily found in fibroblasts, which are essential to maintaining the integrity of the oral tissues.

CONCLUSIONS

Histopathologic and autometallographic examination of the affected tissue indicates that the primary mechanism of the spontaneous sloughing of tissue and loss of teeth may be the cytotoxic effects of the accumulation of mercury in fibroblasts. Studies of additional cases would be valuable to confirm this hypothesis.

Early-onset periodontitis associated with Weary-Kindler syndrome: a case report

Weary-Kindler syndrome is a rare and poorly understood genetic disorder that has manifestations of both epidermolysis bullosa and poikiloderma congenitale. There are approximately 70 cases documented in the past 40 years but no cases appear in the dental literature, although dental findings have been discussed superficially in dermatological and pediatric publications. This case reports on the periodontal findings and treatment for a 16-year-old female diagnosed with the syndrome. Early exfoliation of deciduous teeth, severe periodontal bone loss around many permanent teeth, and fragile bleeding gingiva were key features. Microbiological testing revealed an absence of Actinobacillus actinomycetemcomitans and low levels of other commonly accepted periodontal pathogens. Tests for inflammation, including AST and elastase, were positive prior to therapy and greatly decreased after mechanical root instrumentation. A beneficial effect of non-surgical periodontal therapy was observed in the short-term follow-up.

Periodontal manifestation of hypophosphatasia. A family case report

Hypophosphatasia is a rare inherited disease, the 1st clinical sign of which is often a premature loss of deciduous teeth. We describe clinical, histological and SEM findings of 2 cases of hypophosphatasia from a single family and discuss the pathological mechanisms with reference to the literature.

A histological study of the exfoliation of human deciduous teeth

For clarification of the histological details of the shedding of human deciduous teeth, exfoliated and extracted deciduous teeth were examined by light and electron microscopy. After the roots were completely resorbed, the dentogingival junction migrated along the inner resorbing surface and finally reached the pulpal surface of the crown. At the same time, the gingival epithelium also proliferated and migrated under the crown of the deciduous tooth in such a way that part of it lined the residue of the pulp and another part lined the surface overlying the erupting successional tooth. This phenomenon took place from various sides of the tooth surface. Therefore, just before exfoliation, the migrated gingival epithelium formed narrow necks of tissue, and the crown was only superficially attached to the gingiva by them. The final shedding of the tooth appeared to occur by a tearing of these narrow tissue regions. The results of the present study suggest that the dento-gingival junction as well as gingival epithelium play important roles in the process of exfoliation of human deciduous teeth.

Cementum-like tissue deposition on the resorbed pulp chamber wall of human deciduous teeth prior to shedding

In the later stage of exfoliation in human deciduous teeth, odontoclastic resorption takes place at the pulpal surface of the coronal dentin. However, this resorption does not continue until the teeth are shed, and the resorbed pulp chamber wall is usually repaired by cementum-like tissue deposition. In this study, we examined the formation and characteristics of the cementum-like hard tissue on the resorbed dentin surface in the pulp chamber of deciduous teeth prior to shedding. The site and degree of deposition of newly formed cementum-like tissue on the resorbed pulp chamber wall varied from tooth to tooth. Furthermore, they also showed compositional and structural variations. Generally, however, the matrix of the cementum-like tissue was composed of intrinsic collagen fibers, acellular or cellular. There was a tendency for acellular cementum-like tissue to be deposited on small and shallow resorption bays, whereas the cellular type was found on larger and deeper ones. In both cases, the surface of the deposited cementum-like tissue on the resorbed dentin surface usually became flat. However, unlike the cementum repair of resorbed areas on the root surface, no acellular extrinsic fiber cementum-like tissue was found on the resorption pulp chamber wall. Although the role of the repair of the resorbed pulp chamber wall with cementum-like tissue deposition just before shedding is unknown, it might play some role in the retention of deciduous teeth until shedding.

Hypophosphatasia: a family study involving a case diagnosed from gingival crevicular fluid

Hypophosphatasia is an inherited disorder characterized by defective mineralization of the skeletal and dental structures of the body and deficient liver/bone/kidney alkaline phosphatase (L/B/K ALP) activity. There has been a tremendous advance in our knowledge of this condition over the last decade due to the advent of highly specific DNA probes and novel microanalytic techniques. The purpose of this paper is threefold: to review the dental aspects of current literature about this rare condition; to present a case (and family study) that was diagnosed in a 5-yr-old boy from 0.14 microliters of gingival crevicular fluid, using a new ultrasensitive chemiluminescent assay for the enzyme alkaline phosphatase; and to provide strong evidence for an autosomal dominant mode of inheritance.

Localized prepubertal periodontitis: literature review and report of case

This case describes a young, healthy, white female who demonstrated anterior alveolar bone loss along with premature loss of her primary incisors. The alveolar bone loss remains unexplained. The root surfaces of most of the primary anterior teeth exhibited one or more eroded areas devoid of cementum with some evidence in two teeth of cellular resorptive activity. These findings suggest that premature root resorption was occurring concurrently with unexplained extensive alveolar bone loss. The child will be examined periodically to determine whether this process of bone loss with subsequent tooth loss will involve additional primary or permanent teeth.

An ultrastructural study of tooth resorption in the kitten

Eleven kittens of various ages were used to obtain teeth in situ at differing stages of exfoliation. The teeth were processed by routine techniques for examination by light and transmission electron microscopy. The dental hard tissues were eroded by odontoclasts supported by numerous blood vessels, fibroblasts, and macrophages. No evidence of intracellular collagen was found within any of these cells, indicating that helper cells are not required to remove the collagenous component of dentin and cementum. The loss of periodontal ligament during shedding involved the removal of cells and extracellular material. Two forms of fibroblastic cell death were identified: One, apoptotic cell death, involved condensation, and its occurrence suggests that exfoliation of deciduous teeth is a programmed physiological event; the other occurred in cells containing many profiles of collagen and involved the selective disruption of the mitochondria and eventual dissolution of cytosol. This form of cell death has not been previously described and is significantly different from necrotic cell death, which was not observed during exfoliation. Some fibroblasts maintained a normal morphology. These various cellular responses suggest that phenotypically different populations of fibroblasts may exist in the periodontal ligament. Collagen removal was an extracellular occurrence which did not seem to involve increased phagocytotic activity by fibroblasts.

Eruption of tooth-like structure following the exfoliation of natal tooth: report of case

Natal teeth, defined as those that are the mouth at birth, are rare: one case in 2,000 to 3,500 births. In this case, that of a nine-month-old Japanese boy, it is reasonable to infer that the tooth-like structure, described as a hard-tissue conglomerate with a bone-like appearance, originated in the remnant of the dental papilla and Hertwig's sheath of the natal tooth. Both dentin and root formation were thereby induced.

Ultrastructure of transganglionic degeneration in brain stem trigeminal nuclei during normal primary tooth exfoliation and permanent tooth eruption in the cat

Electron microscopy is used to study changes in the axons and terminals in the cat brain stem trigeminal nuclei, main sensory, and partes interpolaris and caudalis, during the process of natural tooth shedding. Areas previously showing light optical argyrophilic degeneration products and adjacent areas lacking this degeneration are included. Various types of alteration occur early during tooth loss, including increased presumed glycogen, increased cytoplasmic density, flocculence, lucency, and neurofilamentous hyperplasia. By the stage of maximum exfoliation, terminals and axons of marked density become prominent in areas showing argyrophilia, whereas nondense forms occur elsewhere. By late eruption ages, all forms of degenerated terminals and axons are rare, but phagocytes are heavily laden with similar forms of debris. The sequence of ultrastructural events is discussed in light of recent studies of transganglionic degeneration, their correlation with light microscopic findings, and the potential implications for central plasticity in this system.

A long-term survey of tooth loss in 600 treated periodontal patients

1. Six hundred patients in a private periodontal practice were reexamined an average of 22 years after their active treatment and the patterns of tooth loss were observed. 2. During the post-treatment period, 300 patients had lost no teeth from periodontal disease, 199 had lost one to three teeth, 76 had lost 4 to 9 teeth and 25 had lost 10 to 23 teeth. 3. Of 2,139 teeth that originally had been considered of questionable prognosis, 666 were lost. Of these, 394 were lost by one sixth of the patients and only 272 by the other five-sixths. 4. Of 1,464 teeth which originally had furcation involvements, 460 were lost, 240 of them by one-sixth of the patients who deteriorated most. 5. The mortality of teeth which were treated with periodontal surgery was compared with that of teeth which did not have surgery. Tooth retention seemed more closely related to the case type than the surgery performed. 6. In general, periodontal disease is bilaterally symmetrical and there is a predictable order of likelihood of tooth loss according to position in the arch.