consent, autonomy, tooth donation, dental stem cell, qualitative survey, preclinical dental student
Training for operative dentistry and endodontics in Malaysian public universities requires the use of extracted natural human teeth to help students confidently and safely develop clinical skills.1 The use of natural teeth allows students to understand the anatomy of the root canal system and to appreciate the natural hardness of enamel and dentin.2 A recent report released by the Dental Council of Malaysia noted a threefold rise in the number of dental graduates over recent decades3 as well as a decreased need for dental extractions as a result of advances in dental treatment and dental health awareness campaigns. These combined factors have led to diminished supply of extracted human teeth, a challenge which might be resolved by promoting tooth donation for dental education and research purposes.
The concept was explored by researchers from Malaysia through a survey of preclinical dental students in public universities to assess beliefs and attitudes toward tooth donation for research purposes, including stem cell research, as well as the ease of obtaining teeth. The vast majority of respondents (92.9%) found it difficult to obtain extracted human teeth, especially molars. A similar number (96.8%) were willing to personally donate extracted teeth for research purposes, but they preferred to know the type of research that would be done and had relatively little knowledge about research involving dental pulp stem cells. Limited understanding about stem cell research may be due to a lack of exposure to modern research approaches in dentistry.
An earlier study by Ishak et al2 explored whether there was potential in considering tooth donation after death, something similar to organ donation. However, more than half the dental students surveyed were personally not keen on doing so.
Obtaining consent for tooth donation for use in preclinical training or dental research is an issue of some debate in Malaysia. Currently, after an extraction, many clinicians ask patients whether they would like to keep an extracted tooth or consider it biological waste and discard it. Readiness among dental clinicians to advance biobanking of teeth or dental stem cells is limited and has not kept pace with the practice of banking cord blood stem cells. Reasons for this include the facts that storage of extracted teeth and their components is costly and that research awareness is lacking. The topic of research with dental stem cells also remains contested in countries within the region where dental pulp stem cell collection and storage is banned.4
Questions
In what ways could awareness and knowledge about tooth donation be increased in a systematic manner?
What is the proper way to manage the informed consent process for tooth and stem cell donation?
Why might policies in some countries prohibit research with dental pulp stem cells? In countries where policies prohibit or inhibit the practice, what might help to address the underlying concerns?
