Going to the dentist is still very unpopular which is not surprising since it is associated with unpleasant things such as pain and drilling. But regular and timely visits to the dentist can help keep your teeth healthy and beautiful throughout life. Good-bye to toothache! And this can all be accomplished with the proper prophylaxis...

Figure: It does not always have to be sugar! The "tooth fairy" is a label for sweet products such as sweets, chocolate or chewing gum and also cough syrups which taste delicious but do not damage the teeth. "Tooth fairy" products are guaranteed to have been scientifically tested; they cause neither caries nor acid damage to the teeth. They contain sugar substitutes.

Two important diseases affect the teeth: caries and periodontosis (or rather periodontitis). It is generally known and accepted that the former is caused by bacteria which produce acid and that good oral hygiene i.e. regularly brushing the teeth can prevent the formation of plaque and hence caries. It is also beneficial to reduce the consumption of sugar. However, it is less well-known that periodontitis is also caused by bacteria.

What is periodontitis actually?

Periodontitis (which is commonly referred to as periodontosis) is a disease which, if untreated, can lead to the loss of teeth. Moreover, it can have serious effects on the general health. Diseases of the heart and other internal organs and a seven-fold increased risk of premature births caused by periodontitis bacteria are examples of this. Unfortunately, however, the risks of periodontitis are still considerably underestimated. But it is a disease which can be cured if detected at an early stage and can be completely avoided by timely preventive measures. In order to select an appropriate individual treatment it is important to know which factors are responsible for the development and progress of the disease. According to recent scientific discoveries hereditary factors also play an important role. Recently developed test systems are able to give the dentist this important information and thus at an early stage allow the initiation of the correct preventive measures or treatment. 

Figure: The gums are on the retreat. Periodontitis is not a joking matter.

Bacteria and a hereditary disposition are responsible for the development and progress of periodontitis. 

Various factors are responsible for the development, severity and progress of periodontitis. For this reason the symptoms and genesis of periodontitis can differ from individual to individual. Hence in order to treat the individual patients appropriately and successfully, it is necessary to know which factors can be identified in the respective patients as the cause of the disease. Thus for example the presence of certain species of bacteria may necessitate a treatment with antibiotics. Which antibiotic has to be used and in which amount depends decisively on the type and number of microorganisms that are present. In particular the five marker bacteria Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Bacteroides forsythus, Prevotella intermedia and Treponema denticola are causally associated with the formation and progress of periodontitits because they produce and induce substances which ultimately lead to massive tooth detachment and loss of bone. 

Figure: Actinobacillus actinomycetemcomitans which is growing here on the culture dish also grows in the periodontal pocket of many periodontitis patients. Figure by courtesy of  Dr. H. Žemlicková, National Institute of Public Health , Prague, Czech Republic.

Bacterial species such as Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis also have the ability to infiltrate the soft tissue and thus completely escape surgical intervention. If these species are present, a conventional i.e. mechanical periodontitis treatment will be unsuccessful in the mid-term since a  recolonization with bacteria usually occurs and may even increase the patient's discomfort. This can often only be treated with a concomitant specific antibiotic treatment. In this connection it is important to choose the correct and optimally effective antibiotic in order to achieve a lasting therapeutic success. This can only be achieved on the basis of a prior diagnosis using a PCR-DNA probe test (e.g. micro-IDent® test, Hain Lifescience, Nehren). 

How does the micro-IDent® test work?

The test procedure which is completely painless for the patient is very simple: After removing the supragingival plaque and subsequently drying the surrounding region, a paper tip is inserted down to the bottom of the periodontal pocket to be examined and left there for 20 seconds. The paper tip which is now coated with subgingival plaque and sulcus fluid is then shipped in a transport tube. Since the bacterial test is based on the extremely stable hereditary substance DNA, the sample can be transported by mail. Hence it is unimportant whether the bacteria are killed during the sampling procedure or during transport by oxygen which is known to be very toxic for these bacteria since the DNA is not affected by it. The results on the species and number of detected microorganisms are sent out after about one week together with a recommendation for treatment with suitable antibiotics. Hence this forms a well-founded diagnostic basis for the treatment which has a lasting effect. However it should be noted that the micro-IDent® test should only be used for periodontitis with pocket depths of more than 4 mm.

Figure: It is so simple : leave the paper tip for a short time in the periodontal pocket, leave it to dry and send it to the laboratory in a transport container.

Genetic constellations are very important for periodontitis. Dentists encounter patients again and again in which the periodontitis progresses although it is not possible to detect pathogenic concentrations of periodontitis-associated marker microorganisms. In such cases it is probable that the immune system is responsible for the development and progress of the disease. The natural defence system in some people releases large amounts of antibodies (mediators) even when comparatively small amounts of periodontal pathogenic bacteria are present. However, the latter also damage the body's own cells by initiating an inflammatory reaction. As a result there is a rapid degradation of tissue and jaw bone in such patients. If interleukins and similar mediators such as the tumour necrosis factor alpha reach the blood circulation via the inflammed tissue (this can occur particularly in severe generalized periodontitis), serious complications can occur (e.g. thrombosis, diabetes, cardiac infarction or stroke). 

New research results show that susceptibility to interleukin overproduction is hereditary. This means that persons which have such a genetic constellation (so-called positive genotype) have a considerably increased risk of suffering from periodontitis. If periodontitis is already present in such genotype-positive patients, they have a three-fold increased risk of further degradation of the jaw bone and loss of further teeth during the period of periodontitis treatment. If other factors such as smoking or poor oral hygiene are also present, the risk increases to eight-fold.

Figure: Symbolic representation of an interleukin molecule. Interleukins are involved as mediators in inflammatory processes. Changes in the molecular blueprint for these proteins can alter their structure and hence their function which can have far-reaching consequences e.g. in the case of PST mutations. Figure by courtesy of  Prof. C.M. Dobson, Department of Chemistry, University of Cambridge, Cambridge, UK.

A recently developed test can clarify whether a patient has a hereditary predisposition to periodontitis (GenoType® PST). If this is the case the dentist would work out an appropriate individual treatment or prevention plan to slow down or even stop the development or progress of the disease. Hence the test is suitable for identifying patients at risk and enables the planning of appropriate preventive measures. If in contrast periodontitis is already present, the test yields useful information with regard to subsequent treatment.

How does the GenoType® PST test work?

Taking a sample for the GenoType® PST test is uncomplicated and completely painless for the patient. A sterile cotton bud is used to take a simple swab of the oral mucosa by rubbing the cotton swab several times against the inside of the cheek. Afterwards it is sent in a transport tube to the laboratory which gives the results on the sample within a week.

Modern concepts for prevention and treatment are becoming more popular. 

Figure: The doctor and his patient are pleased. Suitable prophylaxis and treatment keep teeth and gums healthy. Figure by courtesy of Dr. T. Roppelt, Kronach.

These new test methods and the classical tests for caries risk diagnosis (e.g. CarioCheck kit, fungiDent test) have irrevocably turned the path from restorative dentistry to preventive, patient-oriented dental care so that you can in future keep on smiling even when you visit the dentists.