Natural Conservative Dentistry: An Alternative Approach to Solve Restorative Problems

Tooth decay is primarily caused by demineralization resulting from acids secreted by bacteria, especially Streptococcus mutans and lactobacillus, which ferment dietary carbohydrates. This occurs in plaque biofilms, which attach to the surfaces of the tooth and become laden with bacteria. Thus, over time, dental caries result from the interaction of three main contributing factors: a diet containing carbohydrates, cariesproducing bacteria, as well as sensitive tooth structure. The use of an antibacterial strategy for treating caries has evolved as a result of (1) identifying certain types of the oral microbiome as the main cariogenic flora and (2) increasing the knowledge of the specific ecology of these cariogenic florae. Combined with this concept, control, and prevention of caries have been sought by reducing the number of bacteria colonizing. Reducing bacterial populations or completely eradicating them from the oral flora would provide an additional reason to prevent dental caries. Several undesirable sideeffects of conventional antimicrobial agents include tooth discoloration and the emergence of bacterial resistance. These side effects stimulate the search for alternative natural anti-microbial agents.

 Non-invasive management of initial enamel lesions using novel remineralizing agents has become the main goal of modern dentistry. Herbs and natural sources with medicinal properties are valuable for treating various oral diseases. Fluoride-mediated remineralization is the cornerstone of caries management. However, many side effects arise from its use, such as dental fluorosis. Most people could accept natural remineralizing agents compared to fluoride-based remineralizing systems. The trend is to use natural ingredients as remineralizing agents to control caries. Different naturally derived agents have been found to remineralize the demineralized enamel lesions efficiently and to prevent caries progression. The growing interest in phytotherapeutics is due to the active biological components of plant extracts and natural products. The active biological components in plants, eggshells, seashells, and other natural products play a significant role in enamel remineralization. Herbal extracts and natural products with remineralizing effects are added to dentifrice and mouthwashes to prevent caries or to enhance the remineralization of initial lesion enamel lesions.

Dentin remineralization is vital for maintaining oral health and preventing tooth decay. Natural dentin remineralizing agents have gained significant attention as a promising alternative to synthetic remineralizing agents due to their biocompatibility, low cost, and minimal adverse effects. This book chapter provides a comprehensive overview of various natural dentin remineralizing agents and their potential applications in dental therapy. The mechanisms underlying the remineralization process, the properties and sources of natural dentin remineralizing agents, and the techniques used for their extraction and formulation are discussed. Additionally, the in vitro and in vivo studies investigating the effectiveness of natural dentin remineralizing agents in restoring tooth mineralization and preventing dental caries are highlighted. Finally, the future prospects and challenges are discussed. This book chapter provides a valuable resource for dental professionals, researchers, and students interested in natural dentin remineralization and its potential applications in dentistry. 

Nowadays, researchers are interested in using extracts from natural sources as medicines or health-promoting agents. Herbs and natural sources with medicinal properties are beneficial for treating oral diseases. Dentistry uses natural products as antimicrobial, anti-inflammatory, and sedative agents. Various physical and chemical factors, including hydrolysis and enzymatic degradation by matrix metalloproteinases (MMPs) derived from the host, degrade bonding over time. Recent biomodifications to dentin have produced a more stable and resilient adhesive contact. It has been determined that plant-derived natural cross-linkers are effective at enhancing the mechanical properties of dentin and controlling its biodegradation by inhibiting proteases. Dentin biomodification by these naturally derived cross-linking agents has remarkable effects on caries prevention and dentin remineralization, which is even more extraordinary. Natural bio-modifiers are naturally occurring substances whose potential dental applications have garnered increased attention in recent years. Compared to synthetic agents, the most appealing characteristics of biomodifiers and renewable/sustainable resources are their minimal toxicity and renewable/sustainable nature. Natural proanthocyanidins (PACs) taken from different natural sources have a high ability to cross-link with collagen. This makes the organic matrix of dentin more biostable and stronger.

Dentin Hypersensitivity (DH) is a common dental problem occurring worldwide affecting almost whole age ranges in the population. It is felt as a short transient pain to cold, hot, and touch stimuli and has different etiological factors. Several treatment strategies, those based on the desensitization of terminal nerve endings or occlusion of widely opened dentinal tubules, were previously proposed as effective agents in the management of DH. However, these agents contained some synthetic components that may have side effects and take longer to treat the condition. Recently, there has been a tremendous shift toward the usage of natural products in the dental field. Naturally occurring desensitizing biomaterials have shown high efficiency in treating dentin hypersensitivity. Little or no side effects, easily available, lower cost, and no need for much special equipment for production or application and preservation are some of the advantages of natural products in comparison to synthetic counterparts. 

Nowadays, bleaching is one of the most common procedures in aesthetic dentistry. When comparing bleaching to other treatment options for vital teeth whitening such as crowns or ceramic laminates, it proved to be more conservative. Bleaching is not only a well-established technique but also provides effectiveness and patient satisfaction. Carbamide peroxide and hydrogen peroxide are the active components used for bleaching. Although bleaching is a well-tolerated method, some patients still report sensitivity during and after bleaching. Hydrogen peroxide is considered the main agent responsible for this hypersensitivity. The bleaching effect is the result of the oxidation reaction of the tooth pigments by means of the hydrogen peroxide molecules. Serious damage to the pulp tissue can be the result of the reaction’s by-products reaching the pulp. The deleterious effect of the bleaching agents is not only on the pulp but also on the gingival tissues and bone, where bone inflammation and resorption have been reported. Therefore, efforts have been made to obtain effective tooth bleaching with less or no harmful effects on enamel, pulp, and oral mucosa and with no contraindications. Natural alternatives to peroxide bleaching have been mentioned in the literature. These alternatives can produce an oxidative reaction and stain removal effects, without deleterious outcomes. Natural products give us some certainty about non-cytotoxic biological behavior, resulting in little or no harmful effects. Also, the organic acids present in raw fruits have demonstrated the ability to maintain or improve the color of the teeth. Therefore, the development of new tooth-bleaching agents based on natural products with comparable aesthetic results and minor side effects would be beneficial.

Discoloration of teeth is a common concern among patients seeking cosmetic treatment. The color of teeth can be affected by various factors, both internal and external, such as ingestion of chemicals or consumption of foods that can cause staining. Currently, there are numerous products available in the market that claim to remove stains and whiten teeth. These options include professional prophylaxis, bleaching gels applied to vital teeth for home use, or supervised application in a dental office. Bleaching gels typically contain varying concentrations of carbamide or hydrogen peroxide and are applied using different methods, resulting in different activation mechanisms that promote tooth bleaching through oxi-reduction reactions. Unfortunately, bleaching agents have an adverse effect on bonding to enamel. This is because of the free radicals generated by the breakdown of hydrogen peroxidecontaining bleaching agents. The free radicals hinder the resin infiltration in the interprismatic spaces, inhibit resin polymerization , and restrict resin tag creation. These free radicals are eliminated from the body within a span of 24 hours to 3 weeks, and the bond strength to enamel is restored. So bonding should be postponed for 1-3 weeks so that the bond strength is restored, but this waiting period is not always clinically possible. The use of antioxidants could be a possible solution to immediately restore the reduced bond strength. Antioxidants could be either synthetic or natural. Although synthetic antioxidants proved to have the ability to restore bond strength, they have many adverse effects. Natural antioxidants could be a good alternative to synthetic ones with no side effects.

Curiosity in pharmaceutical greenery has blossomed due to the expanded productiveness of incoming herbal extract medicine and the rising concern in natural materials to avoid the undesirable effects of traditional drugs. This comes in the same line with the need to keep up pulp liveliness and function of the normal pulp tissue, which is essential for reparative dentin formation. In the previous decade, fully grown adult teeth with pulp exposure had fewer favorable results, and endodontic treatment choice has succeeded over other therapies. Now, eradicating microorganisms from dentin pulp complex and promoting renewal has become the focus of attention. Different materials used in vital pulp therapy procedures help dentin-pulp complex protection; nevertheless, these materials have different side effects, leading to failure of the procedure after a period of time. This article throws light on natural products used in vital pulp therapy procedures that assist in achieving security across pulp-dentin organs with fewer side effects on pulp health over a period of time.

Oral care or oral hygiene products become one of the main components of our daily healthcare products with increased market growth. This is driven by the increased awareness of the importance of a healthy lifestyle to prevent many diseases. For years, many products in this market have been formulated based on pure chemicals, categorized under the toxic category, which could have a negative impact on human health as daily/regularly used products. With the increased awareness of the importance of using natural alternative components as safe and non-toxic ingredients, growing demands have been created for natural dental care products. In addition, with extensive research on human microbiomes and their essential role in maintaining a healthy life and enriching this type of healthy microbes as the first line in fighting against disease, microbiome-friendly products and probiotics-enriched products have been recently introduced to the market. Therefore, the need for innovative and safe products is in high demand nowadays to fill a specific market gap in new niche areas. This chapter addresses the recent developments in the oral hygiene products market and products with comprehensive updates about the growth of the development of natural ingredients-based products in this business sector.