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From Trisha's Desk Trisha E. O’Hehir, RDH, BS Hygienetown Editorial Director

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You Have Stem Cells in Your Palate
– by Trisha E. O’Hehir, RDH, BS, Hygienetown Editorial Director

Did you know you have stem cells in your palatal suture? This came as news to me at a recent continuing education course I attended about epigenetic orthodontics taught by Professor G. Dave Singh.
In the head and neck anatomy course I took many decades ago, we were taught that cranial sutures, although fibrous in newborns, were calcified in teens and adults, and allowed for no movement and no further growth. Cranial sutures of infants were not fused, allowing for growth of the cranial bones to accommodate brain growth. The teachings back then suggested that with age, cranial sutures would fuse so no movement occurred and the suture would become completely calcified. However, the age at which this calcification occurred was the subject of much debate.

Findings based on the use of new technology analyzing cranial bones more closely shows sutures are not completely calcified in teens or adults as was once thought. Researchers found a membrane in the suture separating the cranial bones. This membrane is composed of mesenchymal stem cells, which can differentiate into connective tissue and bone. Therefore, the cranial bones do continue to grow throughout life, even though it may be minimal.

The periodontal ligament (PDL) might also be considered a suture, as the PDL contains stem cells which can be differentiated into fibroblasts or osteoblasts, making new connective tissue and bone. In periodontal disease, we see regeneration of lost tissues, not just repair of the damage. With pressure on a tooth in one direction, we see bone loss. On the opposite side that has been stretched, we find new bone formation, created by stem cell proliferation in the PDL. Considering the extent of the PDL area around all the teeth in an arch, the arch actually can be considered a cranial suture.

Research has confirmed the pulp of deciduous teeth contains stem cells and companies now offer harvesting and preserving of these cells. Dental researchers are working to harness these stem cells through tissue engineering of craniofacial tissues, which would replace restorative materials by growing new teeth. This will certainly bring interesting changes to the clinical setting, but not for several years.

In the meantime, triggering palatal stem cells to grow bone is already being done. Palatal growth is influenced by genetic coding as well as environmental factors, such as thumb sucking and tongue position. For example, if the tongue isn't resting in the palate there will be no passive stretching pressure on the palate to stimulate expansion and growth to provide enough room for all the teeth. Instead, the environmental effect of the thumb instead of the tongue will create a narrow, high palate with inadequate space for all the teeth and therefore crowded, overlapping teeth.

When palatal growth is stopped prematurely for environmental reasons, the mid-face doesn't reach proportional development. Mandibular development will also be influenced by premature interruption of palatal growth. Knowing the palatal suture contains stem cells that can be triggered to grow new bone, even in adults, is exciting news. Based on biology and genetics, Singh designed the DNA Appliance, a retainer that puts gentle stretching pressure on the palatal suture as well as the PDL sutures of the teeth to stimulate new bone growth and expand the palate, no matter how old the patient. Expanding the palate will change the mid-face region and in some cases, open the airway. Yes, you do have stem cells in your palatal suture and genetics is now more of a part of dental care than ever.

Inside This Issue
3 Perio Reports
9 Profile in Oral Health: Peri-Implant Instrumentation Challenges
12 Hygienetown.com Poll: Scheduling
13 Townie Clinical: Non-surgical Radiographic Bone Fill between an Implant and Natural Tooth
15 Gracey Curettes – Help!
17 What is Wrong With Toothbrushes
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