Minding your molars: How ultrasound engineering is transforming dentistry

Ultrasounds - not just for babies! In this episode, we'll be learning how ultrasound technology is helping make dentistry better.

How are we improving dental health so we don't have to keep going back to the dentist?

Anastasios Koulogiannis is a Post Graduate Researcher at UCL. He's looking at engineering applications in healthcare in the department of Mechanical Engineering and so whilst he's not a dentist (although he does have a lot of dental knowledge after spending a lot of time with dentists), Anastasios speaks to us about his research using ultrasound technology and the way its changing dental care.

We cover the 'basis' like what root canal treatments are (did anyone else just think that teeth were inanimate objects?) and how Anastasios and his team are working on a treatment device that will make sure you get the treatment you need, won't have to keep going back to the dentist with tooth pains and will save the NHS money.

Transcript

Ferdouse Akhter 00:06

Hi and welcome to Health in a Handbasket. I'm your host, Ferdouse Akhter, Marketing and Community Manager at UCL's Institute of Healthcare Engineering. In this podcast, we sit down with an expert to learn about all the wonderful and impactful things happening in Healthcare Engineering. Today, we're picking out the topic of dental health, which is quite funny, because for the past week, I've had a toothache and thought about going to the dentist, but haven't actually made it there. So, here I am still suffering. But today's episode, we'll be discussing why dental health is overlooked, how we're using ultrasound technology to improve dental health, and how engineering and dentistry work together, especially when it comes to root canal treatments. And I'm not here by myself. I'm joined by Anestis Koulogiannis. And Anestis is a researcher at UCL. He started his academic life at the National Technical University of Athens, and now he's here at UCL. So hi, Anestis,

Anestis Koulogiannis 00:56

Hi, Ferdouse.

Ferdouse Akhter 00:57

So let's start at the beginning. What is a root canal treatment?

Anestis Koulogiannis 01:01

So when we say root canal, many people think of the root canal treatment itself, but the root canal is a natural cavity we have inside the roots of our teeth. So basically, every every tooth we have has one to four roots, and inside there is a cavity holding nerves and blood vessels. This part of the tooth is called the dental pulp, and is the you can think of it as a heart of the tooth. So in some cases, bacteria can access the root canal start an inflammation, and this is when we need a root canal treatment,

Ferdouse Akhter 01:31

And what causes an infection?

Anestis Koulogiannis 01:34

So bacteria are normally living inside their mouth. However, in some cases, they when we don't brush our teeth, they can take the sugar of our food, ferment it and create some acids. These acids can start penetrating the solid part of our tooth, which is called the enamel, and access the root canal. Another way for them to access the root canal is through gum disease, when our gum shrinks down, giving access to the porous part of our tooth called dentin. So bacteria can move through dentin to the inside and start an inflammation.

Ferdouse Akhter 02:04

Is a cavity when you don't fix it, and the bacteria just creates a huge hole.

Anestis Koulogiannis 02:09

So basically, the black part is dental caries, but it's past, normally the past dental caries, which means that when the bacteria create this acid, they get an access to the inside when the color of the hole is black, that means bacteria already access the root canal. Active dental caries has normally a soft, brown color, still the bacteria has no reach the root canal, so the dentist can still do some cleaning.

Ferdouse Akhter 02:37

It sounds like our teeth can cause us a lot of issues. So why do we have nerves in them in the first place?

Anestis Koulogiannis 02:42

So nerves in general, are receptors of heat and pressure. So the reason we have them in teeth is similar to the reason we have them in our fingertips. It's for us to feel. So basically, nerves inside the root canal let us understand if something is too hot or too cold, and also how we bite. So if we over bite, if we light bite, that's the only way we can feel anything connected to a teeth. Also, another very important reason we have the nurse is to alert us of infections, inflammations and in general, of anything going wrong with our teeth.

Ferdouse Akhter 03:16

So I read a few papers, and I read online that your teeth can cause heart attacks.

Anestis Koulogiannis 03:22

Yeah, there is a connection between the cardiovascular system and teeth, mainly because the bacteria infecting the root canal can move through the bloodstream and go to different organs, creating various health problems. That's also the reason that, in the past, people were dying from tooth infections because dentists didn't know how to treat them.

Ferdouse Akhter 03:42

And so that's why the work you do is so important. So you're working on delivering drugs into our root canals whilst going through root canal treatment.

Anestis Koulogiannis 03:51

So what we're trying to do is optimize root canal treatment in general. To do so we use ultrasound. So first of all, ultrasound will be used to properly disinfect the area, and our next step is to use it as a drug delivery device to target drug particles, to access all the complex dental cavities and kill all the bacteria that lie there.

Ferdouse Akhter 04:11

So when I think about ultrasounds, I think about babies and pregnancies, but it's not the same thing as it.

Anestis Koulogiannis 04:17

No, most people, when they think of ultrasound they think of ultrasound imaging, but in physical terms, ultrasound is any way that it's above the audible limit of our ears. So basically, in this case, ultrasound are delivered through some very tiny needles that are more or less the thickness of human hair. So what the dentist would do is insert these needles inside the root canal. Then, using ultrasound, these needles start vibrating very fast. They vibrate 30,000 times every second and create enormous pressure waves inside the root canal. You can think of it a bit like a pressure washer that we use to clean our yards. So imagine these waves impact the walls of the root canal and removing all the bacteria. At the same time, because we can change the parameters of this vibration, we can actually manipulate drug particles and force them to access some very inaccessible areas, such as the dendinal tubules, which are tiny tubes on the side of our teeth.

Ferdouse Akhter 05:16

So, it's like a two in one device, like a pressure washer, to clean your teeth from this bacteria, and also to deliver drugs into like our gums or our root canal area. Exactly,

Anestis Koulogiannis 05:30

The first part is mainly to clean the root canal from the bacteria. Dentle practice right now is flushing some disinfectants such as hypochlorite inside the root canal and hoping it can kill all the bacteria. So what we want to do is use ultrasound to push the disinfectant to all the cavities of the root canal. And the next step is to try to, instead of a disinfectant, use actual antimicrobial particles to try to kill the bacteria.

Ferdouse Akhter 05:59

So at the moment, this ultrasound needle already exists then - how does what you're doing differ to what's already on the market?

Anestis Koulogiannis 06:06

Yes, indeed, this technology already exists, and many dentists have it. However, they most of them, don't know exactly how to use it to optimize the treatment. What we're trying to do is fully understand the capabilities of the ultrasound and provide the dentist with a method to optimize their treatment and provide the best result for the patient. Because from statistics, we know a properly treated root canal can last for a lifetime.

Ferdouse Akhter 06:33

Do dentists use any specialized equipment to see the root canal? Because otherwise, how do they see into the teeth like that?

Anestis Koulogiannis 06:40

No, during the treatment, the dentist cannot see inside the root canal, and that's the main problem, because they cannot know if they properly disinfected the area. That's why it's important to have a detailed process on how to use the ultrasound to achieve the best result and make sure there are no bacteria left after the treatment.

Ferdouse Akhter 06:57

Okay. And is there a way to check that

Anestis Koulogiannis 06:58

So right after the treatment, you cannot know if it was successful. You will know if, in case of a future infection. However, what we want to do is make sure the the treatment is optimized, and all the dentists know exactly what to do to make sure there there are no bacteria left, and no future infection or potential tooth loss.

Ferdouse Akhter 07:20

Why did you start working on something like this?

Anestis Koulogiannis 07:22

So I'm an engineer. I was always amazed by fluid dynamics and different applications of it. So fluid dynamics is a study of how fluids, like liquids and gasses, are moving under different forces. I was always fascinated by this field. At the same time, I always loved engineering applications in healthcare, so a project combining fluid dynamics and dental healthcare was very interesting for me, and that's how I ended up here doing my PhD in it.

Ferdouse Akhter 07:53

Can your research be used in any other ways?

Anestis Koulogiannis 07:55

So ultrasound drug delivery has different application, especially the way we do it could be, could potentially be used in other porous tissues of our body, like bones, because ultrasound have these particular properties that can push particles and drags even inside the most confined spaces. And that's how this project could have potential other applications. An application of ultrasound that is already been used in drug delivery is mainly in in skin drug delivery. But yeah, potentially there can be many different approaches.

Ferdouse Akhter 08:31

So people must mistake you for a dentist all the time, because, yeah, I did, and you're very knowledgeable, but you're not a dentist.

Anestis Koulogiannis 08:39

No, I'm an engineer. What's funny is, I'm actually, I started my studies as civil engineer. However, during the pandemic, I did an internship in the University of Cardiff. I work on some biomedical application of engineering, again, using fluid dynamics. So I realized I'm fascinated on this field, and that's how I ended up in UCL, working in the Department of Mechanical Engineering in collaboration with chemical engineering and working on a dental healthcare project.

Ferdouse Akhter 09:09

And what do you love about being an engineer?

Anestis Koulogiannis 09:12

I think what I mostly love about being an engineer is using fundamental science like mathematics and physics to understand the world around us and also use them to create solutions for various problems that can be from energy, manufacturing, even healthcare.

Ferdouse Akhter 09:31

And what would you change about your job if you could?