Genetic testing, personalized care may help prevent tooth loss
ANN ARBOR—Using individual patient risk factors, including genetics, University of Michigan research provides new insights into the frequency of dental cleanings that benefit a patient to prevent gum disease that leads to tooth loss.
“Twice-yearly cleanings have been recommended for over 50 years without supporting evidence,” said Dr. William Giannobile, the Najjar Endowed Professor of Dentistry and Biomedical Engineering. “Results showed that one yearly cleaning is likely to be enough for patients with no risk factors. Patients with one or more risk factors, which represent over half of the population, should visit at least twice a year and likely more in some cases.”
In a new study published online in the Journal of Dental Research (the official publication of the International Association of Dental Research), Giannobile and colleagues explored the link between long-term tooth loss and frequency of preventive dental visits (teeth cleanings) in adult patients with and without three key risk factors for periodontal disease: smoking, diabetes and interleukin-1 genetic variations.
The researchers examined dental claims data from 5,117 adult patients who visited the dentist regularly for 16 straight years, had no history of periodontitis and consistently received one or two cleanings each year (each patient had insurance coverage for two cleanings annually).
They assessed individual patient risk factors (smoking, diabetes, genetics) to determine each patient’s risk for progressive periodontitis, including testing DNA collected from participants for genetic variants that regulate a protein that when over expressed, can be associated with gum disease and the destruction of bone and soft tissue that support the teeth.
Giannobile and colleagues say that high-risk patients—having at least one of the three risk factors—receive significant benefit in preventing tooth loss from two dental cleanings per year. In high-risk patients with two or three risk factors, more than two cleanings per year may be needed to prevent tooth loss. In low-risk patients, those who had no risk factors, the second cleaning did not have significant value in reducing tooth loss beyond that achieved with one cleaning each year.
“The future of health care is personalized medicine,” said Giannobile, who also chairs the U-M Department of Periodontics and Oral Medicine. “This study represents an important step toward making it a reality, and in a disease that is widespread, costly and preventable.
“Personalized medicine has great potential in health care to provide very specific patient treatment based not only on clinical symptoms, but also by including genetic risk factors to better identify the risk of disease.”
Dr. Kenneth Kornman, chief executive officer of Interleukin Genetics, which developed the genetics test used in the study, said the approach identified by the U-M research has the potential to improve health care outcomes and delivery.
“We have long known that some individuals are at greater risk of periodontal disease, but tools haven’t been available to adequately identify those at increased risk and prevent disease progression,” he said.
Periodontitis is a bacterially induced chronic inflammatory disease that destroys bone and soft tissue that support the teeth. It is the most common chronic infection of the body and affects up to 47 percent of adults in the U.S., according to the Centers for Disease Control and Prevention. If left undiagnosed or inadequately treated, it often leads to tooth loss.