Genetics-Based Risk Assessment Brings Personalized Preventive Care To Dentistry

From Medical News Today

Interleukin Genetics, Inc. (OTCQB: ILIU) have announced the online publication of the research study “Patient Stratification for Preventive Dental Care” in Journal of Dental Research. The study provides new insights into the prevention of periodontitis (gum disease) and the opportunity for significant advancement in the delivery of personalized, preventive dental care. Periodontitis affects 47 percent of the adult population.

The study explored the influence of three key risk factors for periodontal disease – smoking, diabetes and genetics – on tooth loss given varied frequencies of preventive dental visits that included cleanings. By examining claims data from 5,117 patients without periodontitis throughout a 16 year period and conducting genetic testing, researchers determined that patients with genetic variations of the IL-1 genotype, or one or more other risk factors examined, were at significantly increased risk for tooth loss and therefore require more preventive dental care. The IL-1 genetic variation was the single most prevalent risk factor – nearly one in three Americans carry this genetic variation. This study demonstrates the important opportunity to provide more effective preventive oral care through the use of risk-based patient assessment that includes genetic testing.

Research was conducted under the direction of Dr. William Giannobile, Najjar endowed Professor of Dentistry and Biomedical Engineering, and Chair of the Department of Periodontics and Oral Medicine at the University of Michigan.

Periodontitisis a bacterially induced chronic inflammatory disease that destroys the bone and gum tissues that support the teeth. It is one of the most common chronic diseases of the body. It causes bleeding and swelling of the gums, loose teeth, bad breath and can ultimately lead to tooth loss. Severe periodontitis has been associated with increased risk for multiple other diseases, including cardiovascular diseases, diabetes and rheumatoid arthritis. One in four Americans over age of 65 have lost all their teeth.

“Dentistry has long been a leader in the delivery of preventive healthcare to patients. The findings of this study provide dental clinicians with the opportunity to offer personalized, preventive care that is based on new insights into the importance of genetic risk factors,” said Dr. Kenneth Kornman, Chief Executive Officer of Interleukin Genetics, which developed the genetics test used in the study.

“Personalized medicine is an important frontier in healthcare driven by the clinical application of genetic and molecular information. Genetic-based risk assessment has long promised to improve prevention and treatment of chronic diseases,” said Sir Gordon Duff, Professor Emeritus of Molecular Medicine the University of Sheffield and co-author of the paper. “The findings of this study represent perhaps the first broad scale application of genetics to help prevent a disease that is very prevalent, costly and preventable.”

Periodontitis initiation and progression is driven by two factors: bacterial plaque that initiates the disease and the body’s inflammatory response to bacteria which, when overly aggressive, causes breakdown of the bone and tissue that support the teeth. This inflammatory response varies greatly within the population and is significantly impacted by individual genetic make-up. Genetic testing can identify patients who have an increased inflammatory response to oral bacteria which significantly increases risk of periodontitis and tooth loss. Smoking and diabetes also contribute significantly to the risk of periodontal disease.

“Ultimately, patients should be evaluated by their dentist regularly and receive needed preventive care before any symptoms of periodontal disease appear. This disease can result in disfiguring bone loss around teeth and has been implicated as a risk factor for multiple systemic conditions that benefit from early stage prevention,” said periodontist Donald S. Clem, III, D.D.S., Diplomate, American Board of Periodontology, Past President American Academy of Periodontology. “Historically, we have lacked the prognostic tools to effectively identify patients at greatest risk for periodontitis. This study underscores the need to adopt a genetic, risk-based approach and gives patients a compelling new reason to visit the dentist for a comprehensive periodontal evaluation. As we see with other chronic diseases, identifying and understanding genetic predisposition to disease is a critical component of long term prevention.”

Continuing an occasional series of how dentistry will be revolutionised.

I don’t / won’t read the Daily Mail, perhaps I should in order to see what tripe is published in the name of current research. No doubt this can be filed with “we’ll all be getting our nutrition from a pill whilst commuting using our jetpacks in our dental disease free future” that Tomorrow’s World promised when I were a lad…mind you they did get some things right.

New op to dodge dreaded root canal treatment

• New treatment makes tiny cuts in the teeth, stimulating blood clots
• Op can be performed in two visits – compared to root canal’s 18 months

Dentists have developed an unusual strategy for avoiding the need for root canal treatment – making tiny cuts in the teeth.

Studies suggest that making tiny areas of damage in the nerve root of damaged and infected teeth triggers bleeding, which then forms blood clots.

These clots appear to stimulate blood supply to the tooth nerve, helping it re-grow and avoiding the need for painful and lengthy treatment.

The treatment is being trialled at the University of Liverpool.

In the centre of each tooth is a network of nerves and blood vessels that run from the top, or crown, down to the root, which is embedded in the jaw.

This network is called the root canal system, and the nerves and blood vessels are collectively referred to as the pulp.

Root canal treatment is necessary when the pulp becomes infected, often as a result of injury, tooth decay or a faulty filling.

Treatment involves extracting the tooth or removing bacteria from the root canal system to prevent further decay and, in severe cases, the loss of the tooth.

Removing bacteria involves a dentist drilling into the tooth, removing the infected pulp, then filling the entire system with a type of sealant.

The tooth is then topped with a filling or a crown.

However, because the procedure is so long that it requires multiple visits to the dentist, usually over the course of around 18 months. (sic)

Often this treatment is needed on the large teeth at the back of the mouth, which contain multiple root canal systems.

The new treatment, called revascularisation, can be performed in just two visits.

In the procedure, dentists drill into the tooth and then apply an antibiotic paste to disinfect the canal.

At a second visit two weeks later, the dentist uses a tool to make tiny cuts to the root canal system, until the tissue starts to bleed.

This bleeding quickly triggers a blood clot, which encourages the growth of new blood vessels.

This boosts oxygen and nutrient supply, and helps the pulp repair itself. Exactly how it does this is not clear, but one suggestion is that the blood clot contains a high concentration of growth factors – compounds that help repair damaged tissue.

Early studies have shown that  the technique is successful, and scientists at the University of Liverpool are using it on 30 patients.

Half will have the new treatment and half will have conventional root canal treatment.

Commenting on the new treatment, Hugh Devlin, professor of restorative dentistry at the University of Manchester, said: ‘It’s an excellent technique and is getting a lot of interest in the academic journals.

‘Traditional treatment eliminates bacteria, but prevents growth of a new blood supply to the root.’

(The Greatest Breakthrough Since Lunchtime a reference to Colin Douglas’s book)

An interesting article from The Daily Wail  except that a Google search shows that it isn’t exactly new news.

A new gel that dissolves tooth decay could provide an alternative to the dentist’s drill.

The gel, made from a compound found in the fruit and leaves of the papaya tree, works within a minute to soften up the decay.

This can then be scraped away and replaced with a standard filling. There is no need for a local anaesthetic. The gel is being tested in a clinical trial in Brazil on 30 patients.

Tooth decay occurs when mouth acid dissolves the outer layer of teeth. The mouth is full of bacteria that combine with food particles and saliva to form the sticky film known as plaque that builds on teeth.

Bacteria in the plaque produces acid, which gradually destroys the tooth surface. Left untreated, this can expose nerves in the tooth and cause toothache.

According to the NHS, tooth decay is one of the most widespread health problems in Britain. Some 31 per cent of adults have decaying teeth, and one in three children aged 12 show visible signs of tooth decay.

Early stage decay can be treated with fluoride varnish that may prevent further damage.

But if the enamel has worn away and a cavity formed, decay must be removed and replaced with a filling.

Currently, decay is cleared away using a dentist’s drill, which is not only unpleasant for the patient, but may also damage surrounding healthy tissue.

The new gel is based on papain, a compound that comes from the outer surface of the leaves and fruits of the green papaya, which grows in tropical regions such as Brazil and Hawaii.

Papain breaks down proteins. It is commonly used in laboratories to analyse biological samples.

It has also been used to dress and clean wounds, burns and bedsores because it can break down decaying tissue while leaving healthy tissue untouched.

Early studies at Nove de Julho University in Brazil showed it was highly effective in 13 out of 14 teeth treated.

The team is testing the papain gel on 20 patients, comparing it to a placebo gel.

They hope to release it onto the market in the next three years if the human trials prove successful.

Commenting on the research, Hugh Devlin, professor of restorative dentistry at the University of Manchester, says: ‘This is an interesting material, and may be useful in treating young children.

‘However, we still need more research before this type of gel can be adopted into mainstream dentistry.

‘Generally, we need more spending on research into restorative dentistry to produce similar developments in this country.’

Meanwhile, scientists have revealed how gum disease can stubbornly persist for months and even years.

The team from the University of Pennsylvania, writing in the Journal of Immunology, revealed that the bacteria responsible for gum disease — called Porphyromonas gingivalis — hijack the natural defences of the gum cells and prevent them from sending alerts to the immune system to tell them that they are under attack.

The researchers identified proteins in the bacteria that block the alert response from being launched.

They have developed molecules to silence these proteins, allowing the distress signals to be sent.

In early-stage animal experiments, injections of these silencer proteins into the gums allowed the immune system to clear the infection.

Researchers hope to develop this solution into a dental treatment that can be used easily on humans.