Classifying gum disease genetically could help earlier diagnosis and treatment

Date: Mar-24-2014A study published in the Journal of Dental Research suggests a new

system for classifying periodontal disease that may allow for earlier detection and personalized

treatment before the disease becomes severe.

The researchers propose a new classification system - the first of its kind - based on the

genetic expression of gum disease instead of the current method based on clinical signs and

symptoms.

They say such a system would enable earlier detection of gum disease, and allow

individualized treatment, before teeth and bone loss sets in.

The present system, based on clinical symptoms, classifies periodontal disease as either

"chronic" or "aggressive" depending on how swollen the gum is and how much bone is lost.

However, lead researcher, Panos N. Papapanou, professor and chair of oral and diagnostic sciences at

the College of Dental Medicine at Columbia University Medical Center New York, NY,

explains the problem with it:

"... there is much overlap between the two classes. Many patients with severe symptoms

can be effectively treated, while others with seemingly less severe infection may continue to

lose support around their teeth even after therapy."

He says the problem is they cannot really tell when the gum infection is truly aggressive

until the damage is severe and irreversible.

Researchers inspired by how genetic signatures are used to classify tumors

Spurred by the need for a better way to classify gum disease, the researchers looked at the

recent changes to the way cancer is diagnosed.

Biologists are increasingly finding markers for cancer aggressiveness and responsiveness in

the genetic signatures of tumors, and these are beginning to be used successfully to classify

and select appropriate treatment for individual patients.

To establish whether such a model might work for gum disease, the researchers carried out a

genome-wide analysis of diseased gum (gingival) tissue from 120 male and female patients aged

from 11 to 76, diagnosed with either chronic or aggressive periodontitis.

They found each patient belonged to one of two clusters, depending on the genetic signature

they found of their gum disease. Moreover, they found the two clusters did not align with the

two classes of the current system based on symptoms, but they did differ with respect to extent

and severity of the disease.

The patients whose gene signature put them in cluster 2 had much more serious gum

disease.

Cluster 2 also contained patients with higher levels of infection of known oral pathogens,

and there were more male than female patients in this cluster compared with cluster 1. This was

in keeping with what we know about severe gum disease - that it is more common in men than

women.

Molecular profiling could be basis of new system for classifying gum disease

Prof. Papapanou says the results indicate that molecular profiling offers a basis for a new

classification system based on disease pathology that correlates well with how the disease

presents clinically.

The new system could help spot patients with severe gum disease that has not yet shown

clinical signs, he explains:

"If a patient is found to be highly susceptible to severe periodontitis, we would be

justified in using aggressive therapies, even though that person may have subclinical disease.

Now, we wait years to make this determination, and by then, significant damage to the tooth-supporting structures may have occurred."

He and his team now want to carry out a study where they use the new classification system

with a group of patients that they follow to see how well it predicts disease outcomes.

They also want to find a way to typify the two clusters with biomarkers instead of genes,

because they would be much easier to look for (for instance by analyzing molecules present in gum

samples) than having to perform genome-wide tests on each patient.

Medical News Today recently learned of a paper published in the Australian

Dental Journal that explored epigenetics and oral health.

There, researchers from the University of Adelaide's School of Dentistry, say epigenetics has

much to offer in the future treatment and prevention of dental disease, and predict that one day

a visit to the dentist may well involve looking at how the patient's genes are being switched on

and off.

Written by Catharine Paddock PhD




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