Precision dentistry: Implications for practice

The oral cavity is a dynamic and complex place to work. There was a time when the goal was simple: remove the plaque and fix the problem. Today we are moving toward precision dental medicine and microbial homeostasis.

Currently, the focus is on evidence-based dentistry. This is a well-known concept that utilises the most current and high level of evidence along with experience and expertise of the practitioner. Additionally, the primary goal is to provide a patient-centred plan that meets the needs and is valued by the individual. Precision dentistry takes this to a new level.

The overarching goal is to provide therapy or prevention that will be effective for the individual with a predictable outcome.¹ This seems other worldly but the application in medicine is progressing and the shift to dentistry is not far behind. This focus has been advanced due to the mapping of the human genome and microbiome that have led to ground-breaking research.

A paradigm shift

Precision dentistry requires a complete shift in thinking. Clinical presentation and oral assessment leading to a diagnosis is not sufficient. A clear understanding of the disease, how it differs from health and diagnostic subgroups, or phenotypes, where each member in the group are the same is needed.^1-3

Thus a diagnosis of chronic periodontitis with a recommendation of scaling and root planing is a traditional treatment plan. The outcomes will vary. However, knowing the environment, genetic makeup, biomarkers for health and disease and biological molecules through "omics" research can provide a way to predict or prevent a disease.²

Practice changes

The Periodontal Profile Class system is a step toward precision dentistry.¹ The system is designed to provide a stage and grade that incorporates the risk of future disease and prognosis.⁴ Start evaluating your patients based on their risk for decay, tooth loss, disease progression or poor treatment response, instead of an established disease classification.

Oral-fluid-based analysis shows disease-related proteins and RNAs for oral cancers, Sjögrens' syndrome and periodontal diseases. These, along with information about signaling pathways, enzymes and cytokines could facilitate early intervention, more targeted therapeutic care and better monitoring of the disease. Treatment for head and neck squamous cell carcinoma often results in a poor quality of life and a low survival rate. Classifying these tumors based on their molecular features may help to predict which lesions will convert to a malignancy.³

Prevention

Oral care product research will need to step up the game. Understanding the products' impact on the microbiome will be a key factor. The use of plaque indices to measure the presence or absence of plaque is not only antiquated but also tells us little about disease risk, prognosis or individual responses. Products like the Waterpik^® Water Flosser has shown changes in inflammation on a clinical and microscopic level.^5-8 Research has also shown a host modulation effect and new studies are being conducted and published regularly.^5,6

References

1. Beck JD, Philips K, Moss K, Divarius K, Morelli T, Offenbacker S. Advances in precision oral health. Periodontol 2000 2019;82:268-285. Available from https://onlinelibrary.wiley.com/doi/10.1111/prd.12314
2. Divaris K. Fundamentals of precision medicine. Compen Dontin Educ Dent. 2017 September; 38(8 Suppl):30-32. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5880533
3. Garcia I, Kuska R, Somerman MJ. Expanding the foundation for personalized medicine: Implications and challenges for dentistry. J Dent Res. 2013 July;92(Suppl 1):3S-10S. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728544
4. Al-Mubarak S, Ciancio S, Aljada A et al. Comparative evaluation of adjunctive oral irrigation in diabetes. J Clin Periodontol 2002; 29:295-300
5. Cutler CW, Stanford TW, Abraham C, Cederberg RA, Boardman TJ, Ross C. Clinical benefits of oral irrigation for periodontitis are related to reduction of pro-inflammatory cytokine levels and plaque. J Clin Periodontol 2000; 27:134-143
6. Krajewski J, Giblin J, Gargiulo AW. Evaluation of a water pressure cleaning device as an adjunct to periodontal treatment. Periodontics 1964; 2:76-78
7. Lainson PA, Bergquist JJ, Fraleigh CM. A longitudinal study of pulsating water pressure cleansing devices. J Periodontol 1972; 43:444-446 https://onlinelibrary.wiley.com/doi/10.1111/prd.12314