Germ Cell Therapy: A Better Future In Sight

Mama Dayo gets to the dental clinic, and on entering the dentist’s office, immediately becomes skeptical. “I hope that pharmacist has not referred me to a boy who is wet behind the ears”, she says to herself. Dr Bartholomew can read her concern through her facial expression but remains focused on the little boy who appears to be in pain and is clutching his teeth. They exchange greetings, and the doctor is informed of what happened: "Dayo was playing and accidentally banged his teeth on the wall". Dr Bartholomew is not surprised but reassures the anxious mother that he will explain the situation clearly. After performing some vitality tests, it is confirmed that the pulp is still alive but the injury has exposed it, causing Dayo to feel very sensitive to extremes of temperature and pH. The diagnosis: a complicated crown fracture. Mama Dayo exclaims, as she is not familiar with the medical term. 

Dr Bartholomew explains to her that the issue can be solved and that Dayo would need to be given a temporary pulp covering. He will be given soft diet advice, analgesics, and a follow-up appointment for Cvek pulpotomy; a procedure in which the exposed infected pulp is removed while the remaining pulp is preserved. He informs her that sooner or later, Dayo may need a root canal. As Mama Dayo leaves his office she feels humbled by the dentist, whom she had initially doubted but now trusts.

Once his office is quiet again, Dr. Bartholomew reflects on the last question he was asked. "Is there no permanent solution? A case where my son will not need a root canal?" He responded that germ cell therapy is still in its infancy. Very soon, there may be a permanent solution

Germ cell therapy, also known as stem cell therapy, utilizes stem cells—clonogenic cells capable of both self-renewal and multi-lineage differentiation. The term “stem cell” was first introduced by the German biologist Haekel Wilson. Stem cells have manifold applications and have contributed significantly to regenerative medicine. In dentistry, this concept has led to the use of stem cells to regenerate pulp using dental fillings as scaffolds. A breakthrough in dental history came in the year 2000 when Gronthos et al identified and isolated an odontogenic progenitor population in adult dental pulp. These are referred to as dental pulp stem cells (DPSCs). Other types of human dental stem cells include: 

- SHED(Stem cells from human exfoliated deciduous teeth)

- SCAP(Stem cells from apical papilla) 

-Periodontal ligament stem cells.

Dental pulp stem cells are mesenchymal-type stem cells found inside the dental pulp. They can differentiate into osteogenic and chondrogenic cell lines in vitro and into dentin in vivo, forming part of the dentin-pulp complex. In simpler terms, they can form bones, cartilage, or dentin(dentin is the inner colored layer of the teeth, just below the enamel).

SHED cells can differentiate into a large variety of cell types, including osteoblast-like cells, odontoblast-like cells, adipocytes, and even neural cells.

 

SCAP cells are mesenchymal stem cells residing in the apical papilla of immature permanent teeth. These cells can form odontoblast-like cells producing dentin in vivo. They serve as a source for primary odontoblasts which are essential for root dentin formation. 

PDLSCs possess the ability to generate cementum or periodontal-like structures, thus playing a crucial role in periodontal tissue repair.

How will germ cell therapy help in dentistry? By aiding in the regeneration of damaged dentin, pulp, resorbed root, periodontal tissues, and the repair of perforations. It also significantly contributes to the healing of oral wounds and ulcers. There is so much promise in this field, as highlighted in the case of young Dayo, whose dentin-pulp complex could be regenerated and the long-term vitality preserved if current research advances.

Dr Bartholomew's moment of reverie is interrupted by his secretary, who appears to have been calling out to him for quite some time, her face carries a worried look. Dr Bartholomew straightens up and clears his throat out of embarrassment for having unknowingly soliloquized. He is informed that the next patient has arrived. Though back to work, his thoughts linger on the hope that germ cell therapy may soon reach its full potential to help Dayo and many others in the years ahead, once it finally hits the mark.

Chiamaka Nwandu