Could my periodontal disease be genetic?
One third of the population have a genetic tendency to develop periodontal disease. One half of these individuals will develop the advanced stages of periodontal disease. Many people are born with a “sensitivity” to plaque bacteria – making their periodontal disease much worse. One could describe it as an “allergy”. For these individuals plaque bacteria causes inflammation on contact, triggering the immune system to go into hyper-drive, leading to periodontal destruction. This hyper-inflammatory response creates an over-production of harmful enzymes, allowing chronic periodontal destruction to ensue. It’s important to realize, however, that this genetic variant will actually create periodontal destruction, even in the abscence of, or in the presence of minimal amounts of bacterial plaque.
A simple genetic test called a PST can be performed to determine genetic susceptibility.
The PST Genetic Test identifies patients genetically predisposed to severe periodontal disease. Early detection of patients at increased risk facilitates prevention/early intervention efforts. For those patients already affected with periodontal disease, the PST Genetic Test assists a clinician in creating a personalized treatment plan. The information gained from this test can be useful for all dental professionals and their patients.
The PST Genetic Test detects specific variations in the interleukin-1A and interleukin-1B genes. The presence of these variations (a PST-positive result) increases the risk for periodontal disease 3 to 7-fold and for tooth loss 3-fold. The combination of a PST-positive test result and smoking leads to an even greater likelihood for severe periodontal disease and early tooth loss.
Important information about genetic “exaggerated immune response” your dentist probably doesn’t know and/or hasn’t told you:
Patients with positive PST results overproduce the 2 active forms of interleukin 1, IL-1α and IL-1β.
According to Carranza in the 9th Edition of Clinical Periodontology, IL-1 is one of the pro-inflammatory cytokines that has a central role in tissue destruction.
IL-1 is typically produced by PMN’s (polymorphic neutrophils) in response to a bacterial challenge (periodontal pathogens). However, in the absence of periodontal pathogens, the genetic situation of the patient causes the IL-1 production. To make matters worse, IL-1 up-regulates its own production, resulting in even more production of the cytokine.
IL-1 stimulates endothelial cells to produce chemical mediators that recruit macrophages to the site. The macrophages are then induced to produce prostaglandin E2 (PGE2), which causes periodontal bone loss. IL-1 is also a potent stimulant of osteoclast proliferation, differentiation and activation. As well as inducing periodontal bone loss, IL-1 also induces production of proteinases in mesenchymal cells, including MMP’s, which may contribute to connective tissue destruction. Matrix metalloproteinases (MMP’s) degrade extracellular matrix molecules, such as collagen, gelatin, and elastin.
The bottom line here is that people with the genetic profile are predisposed to exhibit periodontal bone and tissue loss, even in the presence of few periodontal pathogens (regardless of virulence) and even if they have good home care. Host response is a major risk factor for chronic inflammation and continued periodontal breakdown.
Go to www.oraldnalabs.com for more information on genetic testing, as well as the DNA pathogen testing we provide.
For more information on genetics and periodontal disease go to these sites:
The good news is that advanced technologies will now allow us to alter the usually predictably poor outcome of genetic periodontal disease. These individuals are typically blamed for having poor home care, which is not always true. Host factors, such as genetics, must be addressed to effectively put periodontal disease into remission. No longer will only cutting the pockets out with gum surgery, or only doing blind or visual root planing, be the entire solution for many individuals. A synergistic approach must be incorporated involving addressing the hyper-inflammatory response.
Individuals with a genetic predisposition must be identified before anything we do clinically will be successful long term. This type of disease is characterized by the over-production of destructive enzymes (four fold), which causes severe destruction of the bone and gums supporting the teeth. The chronic and subtle nature of this type of disease can fool even the most astute clinician. Damage can occur quickly or slowly, therefore, preventative and more definitive care becomes crucial.
For more information about our non invasive periodontal regeneration protocol go to How RPE works