It begins with plaque and tartar build-up that creates gingivitis; the swollen, tender and often bleeding gums that indicate infection of the gingiva – the delicate, complex tissue that firmly holds the teeth to the gum. Gingivitis is easily remedied by your dentist with a professional clean and often a course of antibiotics. Laser therapy is one of the latest treatments, being a minimally invasive method of removing the affected tissue and the anaerobic bacteria causing the issue.
As the first stage of gum disease, it’s completely reversible. Untreated, it leads to periodontal disease – which is not. Various treatments can manage it but unlike gingivitis, at this point there is no cure.
That’s what makes those 6-monthly dental appointments so important. Early stage treatment is key; gingivitis can appear to go away when the bleeding and tenderness disappears, but essentially it hasn’t and it’s easy to be fooled. The long-term consequence is simply awful: developing the chronic inflammatory disease that is periodontitis. It’s the leading cause of adult tooth, gum, and jaw bone loss.
Microbes live both on, in our bodies. They contribute to how we physically function; and astoundingly, account for one-to-two kilograms of our bodyweight. With around 700 bacterial species that can be found in the human mouth, each of us is likely to host around 300 of these varieties. Oral bacteria interacts to assist digestion, produce chemicals important for health, and although they can protect against pathogens, they can also cause disease.
Diet, and general and oral health designate whether this microbiota is the guardian or invader of teeth and gums.
Microbes, just as their host need food; and like their host it’s plentiful in the mouth. What you consume, your environment, who you kiss, saliva, and the waste products of other micro-organisms are all nourishment.
Eww. There’s a lot going on in there.
Researchers looked closely into periodontitis in 2022. And it’s complicated.
Periodontitis is a chronic inflammatory disease as the result of the unusually aggressive immune response to particular oral pathogens that produces too many anti-inflammatory proteins to the viral invasion.
From the Greek cyto (meaning ‘cell’) and kinos (movement) – cytokines are first responders to pathogen contamination by the immune system.
For example, Porphyromonas gingivalis (P.g.) is a key disruptor to the self-regulating process of cell stability.
It impedes phagocytosis: the biological process of cells engulfing a foreign substance in order to destroy it. These can be non-living particles or toxins, micro-organisms or cells in apoptosis – where the cell death program is activated having been around long enough for new ones to take their place.
It’s this maelstrom that triggers the hostile host retaliation.
The eye on this storm is a research team in the Department of Basic and Translational Sciences at Penn Dental Medicine. It found that measuring specific proteins in the saliva of periodontitis patients tracks progression of the disease.
Specimens were taken from just over 300 participants diagnosed with moderate to severe gum disease, and 115 with no indications.
Samples were collected, tested and monitored every two months over the first year of this eighteen month study.
At the twelve month mark, each periodontitis sufferer was given the standard, non-surgical periodontal treatment of scaling and root planning, medication under the gum line and systemic antimicrobial therapy. Two final checks occurred, three months apart.
Results proved significantly higher levels of inflammation-related signalling proteins in the first year samples of patients experiencing progression of the disease, which was defined as the loss of attachment at three or more sites.
After treatment these saliva protein levels notably decreased. Interestingly, other than in a minimal number of cases the correlating blood samples showed no change.
Ultimately, it’s envisaged that a saliva test kit for dentists – and possibly for patients to use at home – would provide a personalised monitoring method for more efficient outcomes and shorter timelines with the current therapeutic options.
The potential to integrate saliva and blood biomarkers for a more comprehensive, individual assessment was also highlighted by the results of this recent study.
Already, it’s lead to further research from the team. Using samples from the same patients, bacterial species and metabolites are being analysed in order to identify if these too, are useful qualifiers in gauging the advancement or abatement in the course of this gum disease.
In 2021 more than a billion people worldwide were affected by severe periodontitis. It remains one of the major global health challenges, with only minimal improvement observed over the past 30 years. Population growth and ageing forecasts only an increase in its prevalence in the coming decades.
What the team at Penn Dental Medicine in Philadelphia has achieved is not merely a spit in the bucket. With continuing research in other faculties all over the world, it’s opening an ocean of possibilities in optimising and personalising treatment options.
Included in that bucket list is finding a cure for this debilitating disease. Imagine the applause from more than a billion people for that.