The problem with periodontal disease is they’re silent diseases, so most patients don’t
know they have it.
Most patients have a little bit of blood in their saliva when they brush their teeth and
when they spit out and that can be quite benign, it may just mean they’ve got a bit of mild
periodontal disease which we call gingivitis and that’s reversible and it doesn’t lead
to tooth loss.
But many of those patients will actually have a more serious form of periodontal disease,
or gum disease, that they won’t know about.
The most recent evidence we have is from the WHO sponsored study looking at the global
burden of chronic diseases and severe periodontal disease, that’s the really advanced stuff,
that affects about 11.5% of the world’s population.
Online biofeedback technology
Within a couple of minutes we can do a risk assessment and it gives the patient a risk
score for common diseases of the mouth and it also gives them an oral health score.
Risk being the likelihood of something happening in the future and oral health or disease being
what they have at that moment in time and they’re given that on a simple numerical
scale, on a RAG scale which is a red-amber-green colour scale – green being good, red being
bad – and essentially that’s given to the patient and we call it ‘biofeedback’,
to try and help them change behaviour.
The behaviour change might be to spend more time cleaning their teeth more effectively,
it may be to improve their diabetes control, it may be to stop smoking.
So the relevance of that behaviour change isn’t just for periodontal disease it’s
also to general health.
I’m really hopeful that the risk assessment technology will become generalised across
the UK.
I mean it is already but it’s within the private sector, but I’d like to see that
philosophy spread more broadly.
Biomarkers and early diagnostics
The other major area I think for us is in the biomarker diagnostics, early diagnostics,
arena because we have huge expertise through our collaborators in developing novel biomarkers
that we can adapt to saliva based technology and that I see as being a really exciting
area.
So the vision would be within the next five years really to have novel biomarkers developed
– we’re close to that already – to have those evaluated within populations which we’ve
started to do and then to demonstrate in fact that they ‘do what they say on the tin’,
they will in fact predict disease developing or they’ll diagnose disease at a very early
stage.
And then really to get those technologies out into mainstream healthcare.
We can’t do that on our own, we have to do that with our industry partners; they’re
fundamentally important to that and we have a number of exciting collaborations that are
helping us achieve that.
In particular one area, the periodontal disease area, we’re also working with the University
of Newcastle, so it’s a joint university programme with industry and with two healthcare
partners in industry.
Saliva test for cotinine
We did quite a bit of work with Graham Cope from the Wolfson Applied Technology labs as
they were at the University in developing an assay using saliva for measuring cotinine.
Cotinine is the stable metabolite of nicotine.
So we can take a saliva sample from a patient, we can in front of the patient add it to a
tube with some chemicals in – it’s a sealed system – and produce a colour change and
the darker the colour change, the more exposure if you like to cigarette smoke that person
has had.
If I recall correctly, the quit rates went from 6% up to 17% by showing them their test
result.
Next steps
I suppose the most exciting area for us at the moment, apart from the risk assessment,
the oral health innovations system, is the saliva biomarker discovery because that potentially
could lead to very early diagnosis of periodontal diseases, not just in dental practice but
in medical practice, so there are a lot of physicians for example who would like to know
if their diabetes patients have periodontal disease because they’re very aware that
if they do, by treating the periodontal disease it might help the diabetes.
And so we’re working with a fairly major international company at the moment to develop
novel biomarkers and again, adapt those to handheld technology.
So a patient could literally produce a saliva sample and within a minute or so we can get
a result saying whether they have severe periodontal disease or not.