New York University College of Dentistry has been selected as one of five institutions that are sharing a $20.7 million grant from the National Institute of Dental and Craniofacial Research (NIH) to the Forsyth Institute to find new ways to diagnose and fight periodontal disease. As the recipient of a $1.8 million subcontract, the NYU College of Dentistry will screen research subjects and collect biological samples that will contribute to the overall project, “Biomarkers of Periodontal Disease Progression.”
This major, five-year project, involving 500 subjects across all sites, explores periodontal disease from the microbiological, genetic, and immunological perspectives. The goals are to expand the use of biomarkers to understand why people develop periodontal disease, under which circumstances the disease is most likely to progress, and how periodontal treatment impacts patients’ biomarkers.
To varying degrees, periodontal disease affects 40 percent of adults in the United States and can lead to loss of bone that supports the teeth. NYU will focus on identifying biomarkers among 75 subjects with periodontal disease compared with 25 control subjects.
In December 2011, NYU began to collect clinical indicators and biological samples such as saliva, plaque, and gingival crevicular fluid from research subjects. It will send these samples to the Forsyth Institute for analysis to identify biomarkers. The Forsyth Institute is an independent research organization that focuses on oral health.
“Biomarkers are factors in people’s blood, dental plaque, saliva, or tissue that might indicate that they are more susceptible than others to developing periodontal disease,” says Dr. Patricia Corby, principal investigator on the NYU College of Dentistry grant and assistant professor of periodontology and implant dentistry and associate director of the NYU Bluestone Center for Clinical Research. “By identifying these factors, we will be able to design more specific treatments for this condition; thus we’re changing the paradigm of how we diagnose and treat periodontal disease.”
A traditional biomarker for periodontal disease is bleeding on probing. Other biomarkers include a high degree of disease-associated bacterial colonization affecting the tissues that surround and support the teeth or the presence of cytokines—types of proteins that are secreted by numerous cells in the body, which are associated with inflammation. Biomarkers may indicate the presence or absence of periodontal pathogens, gingival and periodontal inflammation, an inflammatory-immune response to certain pathogens, or tissue destruction.
Although these biomarkers can be associated with periodontal disease, they also can be associated with other systemic diseases. To isolate biomarkers for periodontal disease, researchers will exclude any patients with other systemic diseases such as heart disease or diabetes. Because so many periodontal patients do have comorbidities, the researchers expect to screen 10 subjects for each one who fits the criteria.
In addition to looking for biomarkers through this study, researchers are exploring a novel approach to treat periodontal disease. According to Dr. Corby, periodontists generally treat the entire mouth with scaling and root planing—under the assumption that the entire mouth is affected or as a preventive treatment approach. Research at the Forsyth Institute has shown that progression of the disease is site-specific as well as episodic. Patients may do well with a more conservative approach to treatment and steady monitoring to determine whether and where the disease is progressing, says Dr. Corby. Patients in the study will return every two months for monitoring of specific sites and to see whether changes have occurred. In places where the disease is advancing, researchers will treat only the parts of the mouth that are progressing toward disease.
“We want to look at people who respond to this therapy and see how their biomarkers change due to the therapy that we’re proposing,” says Dr. Corby, noting that the presence of certain biomarker microbes might make some sites in the mouth progress more quickly than others. “If the study succeeds (and this is a preliminary trial), it might change the way the profession treats periodontal disease.”
A theory underpinning the study is that periodontal disease is not just a chronic infection, as was once thought, but is related as much, if not more, to inflammation and other immune-system functions. Understanding the biomarkers for inflammation that are associated with periodontal disease will help determine how to treat people.
In addition to Dr. Corby, co-investigators from the NYU College of Dentistry include Dr. Robert Schoor, clinical associate professor of periodontology and implant dentistry and director of the Advanced Education Program in Periodontics; Ms. Rosemary Hays, clinical associate professor of dental hygiene and assistant academic director of the dental hygiene program; Ms. Cynthia J. Howard, clinical assistant professor of dental hygiene and junior research scientist at the NYU Bluestone Center for Clinical Research; and Ms. Judith Kreismann, clinical associate professor of dental hygiene.
The overall project is led by Dr. Richard Teles, a senior member of the staff at the Forsyth Institute and director of the Center for Clinical and Translational Research at Forsyth. Dr. Teles hopes ultimately to develop diagnostic tests to help identify subjects and sites in the mouth that are most susceptible to periodontal disease progression.