Thursday, 10 September 2015

Colgate Oral Health Network: Managing Periodontal Disease by Controlling the Plaque Biofilm

This week I attended an education evening hosted by Colgate at Bart's Dental Institute with Francis Hughes and Mike Curtis about periodontal disease. Here I will talk about their main points from the evening. 



The main debate from the evening was whether or not periodontal disease is an infectious disease. This was an interesting approach to the management of this disease where as clinicians we get caught up in the nitty gritty of scraping root surfaces. 

The issue is when we think of other infectious diseases is that they are normally caused by one species of micro-organisms, whereas periodontal disease has multiple implicated species. In the mouth there is over 1000 different species of organisms - but which one is the key organism in causing periodontal disease?

The idea that disease is caused by Bacterial Dysbiosis has been thought of before such as in Salmonella infections of the gut. This means that unhealthy organisms have a different population and distribution of organisms to healthy ones. 

What is a normal population of organisms?

Our individual make up of organisms is like a unique fingerprint for each of us. It also varies for each site in your body e.g. mouth, skin, intestines. 

The make up in your mouth tends to be the most stable in comparison to other sites, but in some individuals their micro-biomes will be more susceptible to change and therefore to disease. Dysbiotic states are also more easily colonised by other pathogenic organisms. 

So can Periodontitis be transmitted?

There are some studies in mice that have suggested that are germ free can be infected and develop periodontitis if they are in contact with other mice who are inoculated with 'normal' bacteria. 

What are the implications of this?

  • We inherit out oral micro-biomes either by resistant or susceptible dysbiosis
  • This may be preventable
  • Can we use this to reverse the process and introduce a healthy micro-biome?

As clinicians, we are obsessed with the plaque paradigm: that improving plaque control will improve disease severity. 

If you look at the statistics such as the Adult Dental Health Survey, plaque control and mild periodontal disease prevalence have decreased over the years, but the prevalence of severe periodontitis has either stayed the same or even increased according to some data! 
This suggests that in some individuals, disease will develop no matter how a patient's plaque control is like. 

Most of the treatments we provide address removing the biofilm (either mechanically or chemically), and if treatment is effective, teeth of poor prognosis can last for years. 

Limitations of conventional periodontal treatment

Adequate plaque control can be difficult for many patients and for some people, improvement may not be seen if they have severe disease. 

Barriers to effective oral hygiene:
  • Motivation
  • Dexterity
  • Social circumstances
  • Peer pressure
The bacteria in peoples' mouths can also induce a host response which is unique for each person, but also the host response can modulate the bacteria. Smoking is also a massive factor in periodontal disease - you are 4-5 times more likely to develop periodontal disease if you smoke. 

Other factors in periodontal disease:

  1. Smoking
  2. Genetic factors
  3. Systemic factors e.g. diabetes, pregnancy, calcium channel blockers
Up to 25% of diabetics are undiagnosed - this is a huge factor that we need to consider as dentists. There has been some evidence to suggest that good periodontal health can positively affect diabetic control. Together with the 2 million people who are taking calcium channel blockers which can cause gingival overgrowth and inflammation, we need to be aware of factors that can be a cause of severe disease in some individuals. 

Possible future treatments for periodontitis:
  • Anti-inflammatories
  • Anti-cytokines
  • Anti-microbial peptides
  • Probiotics
  • And many more!

We have been treating periodontal disease the same for many years - hopefully with new approaches such as how to modulate the host response or alter the oral micro-biome can help us approach treatment differently. This may help us to treat those with severe disease who may be resistant to conventional treatments. 

Thanks to Colgate and Barts for holding the event and Mike Curtis and Francis Hughes for giving us such an engaging and thought-provoking talk. 

To see a summary of another talk by Francis Hughes, click here

Leave your comments and thoughts in the comments section below.



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