By Dr. Phillipa White, Medical Writer at DRG Abacus
Periodontitis, otherwise known as gum disease, is the most prevalent chronic inflammatory disease in humans, with 45% of the UK dentate adult population having the disease. Periodontitis is associated with increased morbidity; negatively impacting on function, speech, nutrition, quality of life and, ultimately, general health.
Efforts are underway, in both academic and pharmaceutical fields, to establish early periodontitis diagnostic tools and novel therapeutic approaches. DRG Abacus will be hearing more about this at the ‘Dentistry Research Showcase: Science in the Commercial World’ event at the University of Birmingham in May 2017. The School’s research groups will provide an overview of their cutting-edge discovery science and its translation from bench to clinical practice. In the meantime, this is what we know…
Our mouths are home to more than 700 bacterial species that can form plaque biofilms on the teeth and around the gums. If bacteria-containing plaque is not removed it can cause inflammation of the gums, a reversible condition known as gingivitis. Gingivitis is characterised by red, swollen gums that bleed easily. Gingivitis often precedes periodontitis and is routinely caused by inadequate oral hygiene.
Whilst 'healthy' plaque is essential for oral health, if the plaque is allowed to mature in susceptible individuals, pathogenic species emerge and gingivitis can progress to periodontitis. Risk factors that contribute to the initiation and progression of periodontitis include smoking, obesity, poorly controlled diabetes and genetic factors.
Periodontitis causes the gums to pull away from the teeth, resulting in further inflammation, gum recession and the formation of pockets of space around the teeth. If the progression of periodontitis is not halted (e.g. with pharmacological and non-pharmacological interventions), the bone that holds the teeth in the jaw is destroyed, potentially resulting in tooth-loss. Consequently, periodontitis is a leading cause of tooth loss worldwide.
The toxins produced by the bacteria in the plaque stimulate a chronic, inflammatory immune response. Neutrophils are the predominant cell in the periodontal inflammatory response, being fundamental to bacterial clearance. The host response is initially protective; however, in susceptible patients, the immune response becomes dysfunctional and fails to eliminate the pathogenic infection. Discordance develops between the exaggerated host immune response and the bacteria in the plaque, with tissue damage being largely mediated by the exaggerated host response.
Whilst periodontitis has traditionally been viewed as a disease characterised by a localised infection in the mouth, there is increasing evidence to suggest that the disease is not confined to the oral cavity, but has far reaching consequences for general health. A possible explanation for this is that the gums essentially serve as a gateway to the bloodstream, and bacteria residing in the plaque can utilise circulating blood to move all over the body. For example, periodontal bacteria normally found in the mouth have been identified in atheromatous plaques in atherosclerosis. Notably, atherosclerosis is also a risk factor for other cardiovascular morbidities, such as stroke and myocardial infarction.
The prolonged activation of immune cells by bacteria in the plaque can also cause exaggerated responses in immune cells residing all over the body, not just those in the mouth. This perturbed immune response has been linked to the onset and progression of other diseases, such as diabetes and rheumatoid arthritis. Other pathologies that are reported to be associated with periodontitis include obesity, hypertension, myocardial infarction, cancer, complications in pregnancy and systemic lupus erythematosus. Moreover, recent work has demonstrated that periodontitis is associated with increased mortality in patients with chronic kidney disease (CKD), relative to periodontally healthy CKD patients.
Evidence continues to support an association between periodontitis and general health, which warrants increased oral health awareness. In addition, continued efforts from academic research groups and the pharmaceutical industry are needed to manage this prevalent chronic disease.
For further information on this topic, please contact us at access@teamDRG.com, or see the following publications:
The medical writing team at DRG Abacus comprises experts in a large variety of disease areas who develop communication materials that are technically robust, expertly written and presented with impact and flair.
Research at the School of Dentistry at the University of Birmingham is making significant inroads into the understanding of oral health and its close connection with systemic disease. If you would like to learn more, you are invited to an upcoming Research Showcase at the School.
Researchers at the School have won multiple international and national awards:
IADR Distinguished Young Scientist awards: Addison 2016, Cooper 2010.
BSP Sir Wilfred Fish prize: Roberts 2016, White 2015, Sharma 2014, Ling 2013.