10-09-2016, 02:50 PM
Predictive, preventive, personalised and
participatory periodontology: ‘the 5Ps age’ has
already started
1454474154-preventiveperio.pdf (Size: 5.5 MB / Downloads: 5)
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.
Introduction
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. At that time, due to the
weakness of the background in dental researches, just a
small number of dentists were able to perform dental
therapies on a specialised level. In the majority of cases,
advanced therapies were generally considered not more
than pioneeristic attempts. An impressive progress in
dentistry has been recorded in the last decades. Synergic
efforts (understanding of biological phenomena, new biomaterials,
sophisticated surgical techniques, high tech in
diagnostic tools, etc.) have carried dentistry away from the
middle-aged situation described above (Figure 1), but this
is not enough. In order to reconsider guidelines in
dentistry, it is required to introduce new concepts of
personalised patient treatments. On account of this, the
current paper follows the recommendations of the recently
published ‘White Paper’ of the European Association
for Predictive, Preventive and Personalised Medicine
(EPMA) [1,2]. The wave of predictive, preventive and
personalised medicine is quickly incoming in dentistry.
With regard to this, the mission of a specialised EPMA
dental section will be to aid worldwide dentists make a big
cultural effort in changing the actual ‘reactive’ therapeutic
point of view, belonging to the last century, into a futuristic
‘predictive’ one (Figure 2). Enhancement in dental
knowledge revealed genetic, microbiological and immunological
mechanisms at the base of the most common
dental diseases.
The first cause of tooth loss in industrialised world is
periodontitis that strikes prevalently people older than
40 years of age. In consequence of this, the prevention
of periodontitis is of capital importance to general and
oral health since the European population is becoming
progressively older (Figure 3). Periodontitis is a Gramnegative
anaerobic infection whose pathogenesis is genetically
determined and characterised by complex immune
reactions to bacterial burden. It constitutes a very interesting
model of chronic oral pathology, characterised by
activity phases, related to many branches of medical researches
such as genetic, microbiology and immunology.
On account of this, chairside diagnostic tests based on saliva,
gingival crevicular fluid and cell sampling are going to
be routinely used by periodontists for a novel approach to
the diagnosis, monitoring, prognosis and management of
periodontal patients. As will be discussed later, genetic
tests as well as the use of microbial analysis and the detection
of biomarkers derived from host response will
contribute to improve periodontal health. Predictive, preventive,
personalised and participatory periodontology, the
‘5Ps’, represents with no doubt the future of the profession
of periodontology. A predictive approach due to the use of
high-tech diagnostic tools will give us the possibility to detect
patients at risk and to effect early diagnosis of
periodontitis when it is easier to treat successfully. It
will be organised as a personalised prevention, based
upon the genetic and microbiological status of a single
patient as well as personalised therapy tailored with respect
to the particular medical reality of the specific patient.
Finally, the active role of the patient will be
emphasised through the introduction of participatory periodontology, a concept in which networked patients
will shift from being mere passengers to responsible
drivers of their health.