The Seventh European Workshop on Perio took place in 2010 gathering together 78 experts in Periodontology and implant dentistry from across Europe to reach consensus statements on the biology of periodontal and periimplant diseases.
The Results and Discussion of the consensus on Biological approaches to the development of novel periodontal therapies published in the Journal of Clinical Periodontology, was as follows:
“Current preventive and treatment approaches are only partially effective and this appears due to the therapeutic focus remaining primarily upon biofilm management rather than embracing a pivotal role for inflammation as a driver of biofilm composition as well as tissue damage. There is a need to develop new, more effective and efficient preventive treatment approaches for gingivitis and periodontitis which embrace recent advances in the understanding of host modulation as well as direct management of the microbiota”
Possible approaches for controlling inflammation were discussed in terms of modification of the biofilm and modification of the host response. The following categories were examined:
- Antimicrobial peptides
- Probiotics
- Pro-resolving lipid mediators
- Nutritional modulation
To VERY briefly summarise:
Antimicrobial peptides: Several AMPs are present in saliva and GCF. The major sources are in gingival epithelia, neutrophils and salivary glands. Evidence is emerging that deficiencies in AMPs could play a role in periodontal disease. AMPS could have potential for the prevention and treatment of periodontal disease in their antibacterial, anti-inflammatory and/or immune modulatory actions. Approaches that stimulate or restore the natural expression patterns of AMPS might be the most successful.
Probiotics: So far there is only limited data from pilot studies, but these suggest that probiotics have the potential, at least in the short term, to modify the oral microbiota either directly or through the host’s immunological response. Clinical benefits have not yet been demonstrated. It is currently unclear whether it is the antimicrobial or anti-inflammatory effects of such agents which might be important.
Pro-resolving lipid mediators: In the past it was thought that aggressive periodontitis was due to deficiencies or defects in the innate immune response. It is now recognised that it stems from the chronic priming of inflammatory cells which result in increased release of tissue destructive enzymes and reactive oxygen species. It is doubtful that an inflammation-modulating agent will ever completely replace some form of mechanical control of the biofilm, but they may provide an interesting preventive approach against the acquisition or overgrowth of pathogenic bacteria. Pro-resolution lipid mediators are early in development and not yet available for human use. It is possible that dietary micronutrient sources of such mediators (eg omega-3 PUFAs) could be a viable alternative.
Nutritional modulation: There is evidence that diet causes inflammation: directly through post prandial oxidative stress and indirectly through visceral fat accumulation. Conversely restriction of caloric intake reduces clinical and biological measures of inflammation. Increased central adiposity is associated with increased periodontitis prevalence. Association studies have demonstrated an inverse relationship between periodontitis prevalence and intake of fibre, antioxidant micronutrients and PUFAs, and plasma levels of Vitamins D and C, magnesium and combined small molecule antioxidants. At present there is some evidence that suggests that perio outcomes may be improved by Vitamin D supplements in deficient patients and by using phytonutritional interventions. Further studies are however needed. Evidence is emerging that a diet high in fibre, fish oils, fruits vegetables and berries and reduction in intake of refined sugars is of benefit to periodontal as well as overall health.
Periodontal disease susceptibility is more about the host than the biofilm. To find out how you identify your patients’ susceptibility and monitor and manage their outcomes, take a look at our risk assessment tool at www.previser.co.uk
