On a mission to save children’s teeth

Remineralisation would lower the level of invasive care required, but only if the decay can be caught in time

A Fijian dentistry expert studying in New Zealand has advanced global understanding of how to reverse tooth decay.

In 2019, Jason Nath travelled from Fiji to Dunedin to complete his clinical doctorate at the University of Otago on a three-year Manaaki New Zealand scholarship.

Specialising in paediatric dental health, his doctoral research focused on self-assembling peptides to reverse enamel damage before it requires inva­sive treatment.

Dr Nath used peptides on artificially decayed teeth to form a “scaffold”. When ions such as phosphates and cal­cium were reintroduced to these par­tially demineralised teeth, they could more easily grab hold of the scaffold, which enhances remineralisation.

Teeth start to lose mineral content when the mouth’s pH level reaches a level of acidity. A neutral pH in the mouth is between 7.2 and 7.1, Dr Nath says.

Demineralisation occurs when the pH level falls lower than 5.5, “and all the calcium and phosphate ions start to escape the enamel”.

Remineralisation occurs naturally when teeth are appropriately cared for; but Dr Nath’s research proves it can also be performed artificially to aid tooth repair and harden enamel.

He says the remineralisation tech­nique would lower the level of invasive care required, but only if the decay can be caught in time.

Before receiving the Manaaki scholar­ship, Dr Nath was a qualified dentist and assistant lecturer at the School of Dentistry and Oral Health at Fiji Na­tional University.

He had no formal postgraduate train­ing in dentistry but, while he was teach­ing, he obtained postgraduate qualifications in public health.

Prospective clinical doctorate students at the University of Otago usually must complete primary exams first but, because Dr Nath had post­graduate qualifications and about nine years of clinical dentistry experience, he was given automatic entry.

After completing the scholarship and returning to Fiji, Dr Nath was promot­ed to assistant professor.

Back home, he is working to change oral healthcare behaviour, starting with parents and children.

Dental hygiene problems in the Pa­cific stem from lack of education and resources, he says.

“When a child presents with a mouthful of decay it’s not their fault.”

Given the shortage of dentists in Fiji, Dr Nath says dentists often don’t have time to talk parents through caring for their baby’s teeth, so children don’t build healthy dental habits.

He says the issue affects the whole health sector: “We need nurses and pharmacists and doctors to start talk­ing about teeth.”

Dr Nath says parents need to estab­lish good oral health habits with their children, such as brushing twice a day, avoiding sugary foods and having reg­ular dental check-ups.

Dental fear and anxiety is a real prob­lem: “We need to be positive about go­ing to the dentist. Children are scared, they do not want to go to the dentist. Parents need to introduce them early, not wait until they are in pain and need invasive treatment.”

Parents need to be equipped with an oral health plan before their baby is born, Dr Nath suggests.

“Perhaps during pregnancy check-ups, the nurse could point out develop­mental milestones for your child’s oral health: when your first dental visits should be scheduled, what you should be feeding the baby, and tips such as not putting your baby to sleep with a bottle.”

As a result of Dr Nath’s work, use of biomimetic remineralisation of early enamel lesions is now a common area of research. Further investigation is under way in the cariology and minimal invasive dentistry experiments pro­gramme at the University of Otago, he says.

Dentistry honours student Kerry Chen is running analysis on the remin­eralisation potential of selected pep­tides, with Dr Nath as co-investigator.

He says new research in both Fiji and New Zealand is finding huge benefits in regularly drinking fluoridated water to strengthen enamel and bring down the pH level in the mouth. Fluoride makes the enamel more resistant to de­cay, which means teeth can withstand a more acidic pH level before they start to demineralise.

While the health benefits of drinking water have been widely established, the oral health benefits “from the frequen­cy of drinking water – that’s new”, he says. This is a complicated issue in Fiji, where many communities rely on nat­ural streams and wells which do not have natural fluoride content.

In New Zealand, 14 local authorities were recently directed by the Ministry of Health to fluoridate their water supply, and can apply for a share of $11.3 million allocated for the associ­ated capital projects.

Once these supplies are complete, between 51 and 60 per cent of New Zealanders will have access to fluoridat­ed water, the ministry says in a media release.