DT Online spoke with Prof. Thimios Mitsiadis, Head of the Institute for Oral Biology at the University of Zürich, about stem cell research in dentistry and what the chances are to recreate teeth.

DT Online: Prof. Mitsiadis, which factors determine the formation of enamel?
Prof. Thimios Mitsiadis: This is a very complex process, which is determined by the dental epithelium at a very early stage and different to that of the skin epithelium that covers the body. There is a multitude of transcription factors, one of which is Ptx2, which governs the formation of oral and dental epithelium. Based on this, there are other transcription factors. At the moment, we only know of Tbx1, which co-forms the ameloblasts. Of course, there are further transcription factors that we do not yet know much about and that are regulated by certain growth factors. The transcription factors occur within a very tight time frame to form enamel. It is a highly complex process from the beginning to the final formation.

Which factors may disrupt the formation of enamel?
Dental enamel can be damaged from the start because there are genetic factors that disrupt the correct formation of enamel. However, epigenetic factors that occur during the course of a pregnancy, for example, result in a deterioration of dental enamel through discolouration.

In addition, we are currently examining the effects of fluoride. Fluoride protects the tooth but may also lead to its decomposition during the process of dental enamel formation. Other epigenetic factors, such as the consumption of alcohol, can affect the formation of dental enamel.

Dental erosion is a growing problem, which is certainly driven by the increase in life expectancy. However, statistics demonstrate that younger patients are also increasingly being affected. What is the cause of this development from your point of view?
Yes, it is a fact that loss of enamel has been detected mostly in elderly people. In my opinion, two factors have to be considered here. Nowadays, we know much about prevention, but in the past many people did not take care of their teeth sufficiently. General health conditions and other diseases were considered more important. Research and medication in these areas have improved significantly. Over time, however, we realised that we had not paid sufficient attention to our many dental problems.

Another possible reason is migration. We tend to travel more and live in various countries. For example, I was born in Greece, but now live in Spain with my Spanish wife. My children, therefore, possess features of both nations. This may result in abnormalities and deterioration of enamel.

What innovative perspectives have arisen from these new findings?
These are exciting times in which we live. It is evident that in the near future—in about 20 to 30 years—we will be able to create new tissue with the aid of microbiology and genetics. Clinical studies that examine the use of dental stem cells for the regeneration of jaw bone are already underway. This is proof that progress in this regard is being made. We just need more information on how to achieve natural protection.

What progress has been made in stem cell research for the formation of enamel?
We recently formed a European consortium with researchers working with stem cells in Germany, Finland, Switzerland, Italy and France. The consortium’s objective is to isolate stem cells from teeth, the face and the head, and to use them to generate products. With stem cells, for example, natural implants could be produced. There are also tests being conducted in Italy to recreate teeth, but in my opinion this is far too complex to be realised at the moment. At this stage, we should only concentrate on creating tissue as a replacement for damaged or destroyed material, such as dentine and dental tissue.

Thank you very much for the interview.

This interview originally appeared in DT Germany No. 4, Vol. 7, 2009. Translation was provided by Annemarie Fischer, Germany.