Periodontitis has always been challenging to treat.
What begins as gingivitis, the mildest form of gum disease, untreated it progresses to a severe gum infection that can lead to tooth loss, jaw bone loss, and a raft of resultant health complications. With the physical changes it brings to once beautiful, healthy smiles, it’s a distressing affliction, with an acute impact on self-confidence and social interactions. Its causes range from genetics and lifestyle choices, to mismanaged oral health care. The specific bacteria responsible for this chronic infection is also biologically linked to depression and diabetes.
Depending on its severity, treatment options have been largely limited. Scaling, root planing and the invasive options of pocket reduction or flap surgery, bone and tissue grafting, and tissue regeneration have been the basic treatments for the past 40 years.
Guided tissue and regeneration treatment (GTR) sounds sci-fi, but it’s been a therapeutic choice for more than a decade. Disease-causing bacteria is removed from below the gum line, and by placing a membrane between bone and soft tissue, healthy regrowth of both is stimulated. This is done so that slower growing bone fills the space, rather than the more rapidly regenerating gum. Otherwise there’s no stability for the teeth undergoing this particular dental therapy.
Platelet-rich fibrin (PRF) is another oral surgical procedure that again, has been utilised for a long time. It involves withdrawing the patient’s blood and immediately placing it into a centrifuge. This speeds up the conversion of the blood protein fibrinogen to fibrin (a clotting component), while retaining the platelets. It’s a concentration that promotes a faster natural healing in the affected areas of the disease.
In 2024, associate research scientist in the Department of Molecular Pathobiology at NYU Dentistry, Dr Yugi Guo and her team have developed a topical gel and oral strips that can be used at home by those both at risk, and experiencing gum disease. A more intense, slow release formula for dentists to use on the pockets that form around the base of the teeth in affected areas forms part of this ingenious undertaking. Its perspective and results are so impressive it won the 2023 STAT Madness Award, an honour for innovative research in science and medicine.
In the same year, another recent change in therapy for periodontal disease began development. With a few years to go before it will be approved for use, its research results are astounding. Unlike all other approaches to chronic gum disease, this gel and oral strips target and block succinate – a natural the receptor molecule that becomes elevated in periodontal patients. Disabling it counteracts the soft tissue inflammation and bone loss, and effectively shuts down the disease.
The gel and strips will allow home treatments, while a more concentrated version will be supplied only to dentists for professional application in a repair regimen. That’s certainly another Eureka! moment, and pure gold for patients and practitioners.
Since 2015, Flightpath Biosciences’ co-founder Kim Lewis PhD, Director of Northeastern University’s Antimicrobial Discovery Center, has sought to identify a selective compound against the particularly destructive spirochaete pathogen, Borrelia burgdorferi. A number of species and strains of this bacteria spread to humans by infected ticks, are responsible for Lyme disease – a debilitating condition that can affect digestion, joints, nervous system, heart and brain. Recently, FP-100 (hygromycin A) was found to do that specific job that’s taken almost a decade to find; and impressively, it doesn’t harm healthy gut bacteria.
Even better, it was revealed that this narrow spectrum antibiotic also successfully eliminates Fusobacterium nucleatum. An opportunistic bacterium commonly found in the mouth and when left unchecked, leads to severe gum disease, dental pulp infection, oral cancer and their associated systemic diseases.
Which is precisely why you should never rethink the value of a six-monthly dental appointment.
FP-100’s multiple proof-of-concept studies in other disease areas means its brilliantly broad for a targeted micro-organism treatment. Endometriosis, infertility, pre-term and stillbirth too, will benefit from the findings. What it also changes in terms of the antibiotic treatment paradigm is its keeping of sensitive, favourable gut microbiome – and ergo, oral microbiota – intact. Incredible game-changers in the realm of human healing.
A landmark Collaboration Agreement with the ADA Forsyth Institute to specifically develop FP-100 for the treatment of periodontal disease was signed in 2023.
That FP-100 eliminates F. nucleatum from the mouth, reverses the destruction caused to the gums and completely stops the progression of the disease is irrefutable. The Institute’s senior leading scientist of the study, Alpdogan Kantarci, DDS, PhD has said, “This type of black-and-white data almost never happens.”
Research is also being carried out on infrared thermography and metabolomics profiling. These are futuristic methods that will soon allow practitioners to detect disease at the molecular level; pushing periodontal diagnostics into the sphere of precision medicine.
In this first quarter of the 21st century, periodontology is a field transformed.
Groundbreaking research and leading-edge technology means treatments for restoring and maintaining gum health are less complex, less invasive and with more reliable outcomes.
With all that will be available in the future, right now even the most skilled periodontist no longer has an element of guess work in treatments. Advanced 3D imaging, such as Cone Beam CT scans give distinct, and unmistakably detailed oral cavity images. Coupled with AI, analysis is more exacting than ever before. Sites of future bone loss are identified; along with areas of gum inflammation that are yet to show symptoms. This type of early diagnosis designates that issues remain minor, and more easily treated.
Salivary diagnostics also ensures early detection. The critical biomarkers of specific bacteria and inflammation are revealed without anything more than a sample. Anything that tells your dentist precisely what’s happening with your oral health allows for therapies to be administered in the early stages – which has always been the preference with or without technology.
LANAP (Laser Assisted New Attachment Procedure) has been around for a while, with patients benefitting from minimal bleeding and discomfort, and just the selective removal of diseased gum tissue. Another innovative solution to chronic gum infection is Antimicrobial Photodynamic Therapy (aPDT). Light-activated compounds directly target the cause; destroying the harmful bacteria without the need for surgery or antibiotics.
It’s been long recognised how important a role oral microbiome plays in gum health. New research no longer focuses solely on eradicating the pathogens responsible, but instead on how to balance this biota so that the risk of disease is naturally reduced.
What once entailed invasive surgery, great discomfort, long recovery and outcomes that could not be assured, can now be handled with lasers, light therapies, and tools of continually advancing technology. Diagnosis is rapidly moving from X-rays and expert observation, to precision AI analysis. The once sci-fi dream of regeneration is becoming a reality with stem cells and gene therapy. Coupled with the digital dentistry of AI and robotics, the permanent reshaping of the patient experience is already underway. With that, the primary goal of global optimal oral health is becoming more and more attainable.
The bright future of gum disease is that it will one day soon, be designated to the dark annals of history.
