Tackling Complex Pediatric Oral Health Challenges

Dr. Pamela Den Besten hopes to discover how to reengineer tooth enamel and possibly help other scientists manipulate stem cells to regenerate teeth.

As a new dental graduate, Pamela Den Besten, DDS, MS, appreciated the idea of pursuing scientific research alongside patient care. “Being a scientist is like being the ultimate explorer,” she says. “I loved that I might learn and discover something nobody else in the world knew.” 

Becoming a pediatric dentist may have been the perfect career choice for her. She was attracted to the profession in part because she admired people who worked with children. “They always seemed a little childlike themselves and open to doing things differently,” says Den Besten, who admits that she has always sought to implement change, not just follow. 

“I started out in dentistry with a few basic questions,” she says. “What is a tooth? How is it connected to the rest of the body? How does it relate to oral health, and how does oral health relate to our general health?” As director of the UCSF Children's Oral Health Research Center, she bridges the gap between clinical care and research and works to unravel the mysteries of tooth development and disease. 

Perhaps the most ambitious research area Dr. Den Besten champions is gaining a better understanding of the biological mechanisms that lead to tooth formation. She hopes to discover how to reengineer enamel because poorly formed enamel increases the susceptibility of teeth to cavities, cracks, and erosion. Understanding the process by which enamel and dentin – the bony tissue under the enamel that forms most of the tooth – is created could help other top researchers in UCSF’s Craniofacial Center accomplish their bold challenge to engineer stem cells to regenerate teeth

Dr. Den Besten also studies the special dental-care needs of children undergoing treatment for cancer and other autoimmune diseases such as type 1 diabetes. In collaboration with UCSF’s Bone Marrow Transplant Unit, she is helping manage a clinical trial that is testing a tooth gel designed to prevent infections in the mouths of immune-compromised children being treated for blood cancer. Infections caused by oral bacteria can spread to the bloodstream and cause serious complications. By helping severely ill kids keep their mouths healthy, Den Besten expects to learn information that will serve all children. 

Regardless of what Dr. Den Besten is pursuing, she continually pushes the limits of what’s possible. On the patient-care front, she is empowering parents and children to understand more about the importance of oral health using technology, artificial intelligence, and other tools. She believes patients can and should play a far greater role in the decision-making process around their own dental care. 

“There’s so much more for us to understand and teach about the mouth,” she says. “UCSF is an amazing environment where people are willing to help me with whatever I’m interested in.” 

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