As common as the "common cold"? It's a fact that periodontal (gum) diseases, caused by bacteria living at or below the gum line, are among the most prevalent infectious conditions in humans. Forsyth's translational research in periodontology, spanning the lab and the clinic, is pointing the way to match the right treatment to each patient.
As Anne D. Haffajee, B.D.S. and head of the Forsyth Department of Periodontology, explains, gum infections pose serious health problems. Within the complex biofilm communities – commonly known as dental plaque – that live at or below the gum line, some species of bacteria destroy the soft tissue and bone that support the teeth. These bacteria may also migrate to other parts of the body, increasing the risk of such health problems as diabetes, obesity, cardiovascular disease, stroke, and premature births in pregnant women. Periodontal diseases are also associated with tobacco use. Little wonder that finding the best therapies to prevent and treat periodontal diseases is the ultimate goal for Dr. Haffajee and her colleagues. This goal is all the more challenging because not all patients respond to existing standard therapies used by dentists in the same ways.
Basic science researchers in the Department of Periodontology at Forsyth, use high-tech tools to understand oral ecology by identifying the bacteria in the biofilm communities, seeing how they interact, isolating disease-causing pathogens, and examining the effect of treatment. Because hundreds of species of microorganisms live in the human mouth, Forsyth investigators developed a high throughput analytical technique termed checkerboard DNA/DNA hybridization that has enabled them to analyze more than 270,000 oral microbial samples over a decade in periodontal studies. The new, Forsyth-developed Human Oral Microbe Identification Microarray (HOMIM) now supplements this technique to investigate species that cannot be cultured in the laboratory. With these techniques, Forsyth researchers have been instrumental in defining the pathogens in periodontal diseases, and they are now assessing the possible relationships of the bacteria that colonize the mouth in systemic disease processes.
Developing successful therapies for treatment of periodontal diseases is very challenging because not all patients, even those with the same clinically classified disease, share the same bacterial profiles. Since one treatment is not likely to be effective for everyone, Forsyth has focused its work on "matching" the optimal periodontal therapy to a patient's specific bacterial infection. This research has involved novel combinations of therapies, including systemic antibiotics, that have proved to be effective and have been adopted by some clinicians in practice.
Another avenue of research is aimed at preventing the onset of periodontal diseases. This process begins with identifying factors that increase the risk of these diseases, such as high levels of periodontal pathogens and behavioral and environmental factors. A new study suggests that a connection between overweight and obese individuals, particularly younger females, and a particular oral pathogen may put these people at risk for gum disease in the future. Forsyth investigators have also examined the relationship of genetic markers, smoking, and geographical location to periodontal diseases. In collaboration with other researchers, they are investigating the possible connection of a wide range of conditions, including Sjogren's syndrome, Down syndrome, and inflammatory bowel disease with periodontal infections.
Ricardo P. Teles, DMSc, an Associate Member of the Staff in the Department of Periodontology, has brought the body's immune response to the bacteria responsible for gum diseases into the research picture. In addition to infection with these pathogens, the individual patient's immune response is now recognized as a major factor in the risk and extent of the disease. Immune mechanisms may also be mainly responsible for the tissue destruction that the disease causes. Specifically, Dr. Teles studies gingival crevicular fluid, which collects between the gums and the teeth, to determine how the inflammatory mediators it contains correlate with the biofilm communities and clinical disease manifestations. Understanding immune responses will contribute to developing individualized treatments for patients who need more than standard therapies, and for distinguishing between the active disease and remission states that characterize periodontal infections.
Translational medicine stimulates new ideas by integrating clinical studies with laboratory analysis. Forsyth has the benefit of a dental clinic and periodontology lab under one roof, enabling researchers to conduct studies that could not otherwise be accomplished, such as those requiring live bacterial samples. As a clinician-scientist, Dr. Teles links Forsyth's clinical research to its basic science laboratories. The individuals who participate in Forsyth studies gain the benefit of free periodontal treatment by the clinical staff, and more than 1,000 such patients have been served. At any one time, there are generally multiple trials of about 200 subjects each, as well as numerous smaller studies. By combining ecological and immunological approaches with clinical data, periodontal research at Forsyth is advancing toward its goal of eliminating these diseases worldwide.
