Abstract
An impressive progress in dentistry has been recorded in the last decades. In order to reconsider guidelines in dentistry, it is required to introduce new concepts of personalised patient treatments: the wave of predictive, preventive and personalised medicine is rapidly incoming in dentistry. Worldwide dentists have to make a big cultural effort in changing the actual ‘reactive’ therapeutic point of view, belonging to the last century, into a futuristic ‘predictive’ one. The first cause of tooth loss in industrialised world is periodontitis, a Gram-negative anaerobic infection whose pathogenesis is genetically determined and characterised by complex immune reactions. Chairside diagnostic tests based on saliva, gingival crevicular fluid and cell sampling are going to be routinely used by periodontists for a new approach to the diagnosis, monitoring, prognosis and management of periodontal patients. The futuristic ‘5Ps’ (predictive, preventive, personalised and participatory periodontology) focuses on early integrated diagnosis (genetic, microbiology, host-derived biomarker detection) and on the active role of the patient in which networked patients will shift from being mere passengers to responsible drivers of their health. In this paper, we intend to propose five diagnostic levels (high-tech diagnostic tools, genetic susceptibility, bacterial infection, host response factors and tissue breakdown-derived products) to be evaluated with the intention to obtain a clear picture of the vulnerability of a single individual to periodontitis in order to organise patient stratification in different categories of risk. Lab-on-a-chip (LOC) technology may soon become an important part of efforts to improve worldwide periodontal health in developed nations as well as in the underserved communities, resource-poor areas and poor countries. The use of LOC devices for periodontal inspection will allow patients to be screened for periodontal diseases in settings other than the periodontist practice, such as at general practitioners, general dentists or dental hygienists. Personalised therapy tailored with respect to the particular medical reality of the specific stratified patient will be the ultimate target to be realised by the 5Ps approach. A long distance has to be covered to reach the above targets, but the pathway has already been clearly outlined.
Highlights
Not too many years ago, the most frequent therapy in dentistry was tooth extraction: the teeth were pulled out and rapidly substituted by the application of a fixed or mobile prosthetic appliance
The aim of this paper is to synthetically report actual information on the genetics, microbiology and immunology of periodontal disease related to biomarkers that can aid to have early diagnosis
Oral fluid is the mirror of periodontal health
Summary
Not too many years ago, the most frequent therapy in dentistry was tooth extraction: the teeth were pulled out and rapidly substituted by the application of a fixed or mobile prosthetic appliance. We intend to propose five diagnostic levels (hightech diagnostic tools, genetic susceptibility, bacterial infection, host response factors and tissue breakdown-derived products) to be evaluated with the intention to obtain a clear picture of the vulnerability of a single individual to periodontitis in order to organise patient stratification in different categories of risk (Figure 30). Fourth and fifth diagnostic levels: host response factors and tissue breakdown-derived products At present, well-studied molecules associated with host response factors and with derived tissue destruction mediators have been proposed as diagnostic biomarkers for periodontitis [102] Many dental associations, such as the American Dental Association (ADA), recognise the importance of continued research on oral fluid diagnostics and welcome the development of rapid point-of-care tests that provide accurate measurements of clinically validated biomarkers. A statistically significant correlation between the GCF content of C-4-S, a bone-specific glycosaminoglycan, and PPD and CAL was reported [127]
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