Familial aggregation studies focused on members of families who had a history of aggressive periodontitis. (2009). In addition, Gomez, Dutra, & Moreira (2009) reported in preliminary studies that hypomethylation of IL-6 gene was found in people with periodontal disease. Offspring receive both maternal and paternal copies of each gene during meiotic replication. This person asks about the sticky area of dental patients who refuse treatment. The physical pain of the helping professions, Christa Crilley McConaghy, BS, RDH, PHDHP, recounts her personal story of musculoskeletal pain from years of trauma and improper ergonomics that her hygiene career took on her body. More research was conducted to determine better ways of testing susceptibility to periodontitis much earlier on before an individual is infected by the disease. Thus, a genetic defect resulting in subnormal salivary levels of such antimicrobial substances could render the host more susceptible to bacterial colonization and subsequent periodontal breakdown. As a result of these studies, they were first able to ascertain that a cell-migration defect - i.e., inability or slowness of movement - represented one component of the pathogenesis of a form of periodontal disease. The biggest factors noted are environmental in nature and changed the phenotype and pathogenicity of each patient. Dr. Tokuhata referred to this as a "booster factor.". These "markers" for disease actually are functional. These changes were noted as having been passed on to the Holocaust survivor’s offspring (Yehuda & Bierer, 2009). Part 2 of 3. The good news is that the list of acknowledged and proven periodontal risk factors is relatively short and well-understood. 625). 2. Biological sciences including genetics and epigenetics can be analyzed for how gene regulation affects the body's immune response to an inflammatory disease, including periodontal disease. Up to 30% of the population may have some genetic susceptibility to periodontal disease. In 13 sets of identical twins over the age of 25, severe periodontitis was detected in four twin sets. (2008). This reminds us of the 1964 paradigm, established by Dr. Tokuhata, for smoking and lung cancer: Tobacco alone does not cause the disease; rather, there is a synergistic interaction between tobacco and one or more familial-host susceptibility factors. This leads to a new paradigm in periodontics, based on risk and susceptibility, rather than on plaque-antiplaque exclusively. Although large clinical studies of family groups and twins have provided valuable evidence of a strong hereditary component of periodontal disease susceptibility, such studies do not provide information about individual susceptibility. Papillon Lefevre Syndrome (palmoplantar hyperkeratosis and aggressive periodontitis) was noted as an autosomal recessive disease and showed severe periodontal disease manifestations (Tarannum & Faizuddin, 2012). Julie Whiteley helps you in the hunt for your magical unicorn. Giannobile WV, (2012), Salivary diagnostics for periodontal diseases. These effects were in all cells or in specific tissues within the body. His diagram shows the synergistic interaction between the familial factor and the tobacco factor. Genes and gene polymorphisms associated with periodontal disease. In conclusion, it is hoped that through epigenetic manipulation that controls the enzymes that increases production of cytokines, including IL-1 and IL-6, that it would become therapeutic for many inflammatory diseases, including periodontitis (Gomez, Dutra, & Moreira, 2009). Complex genetic diseases (polygenic disorders) are the result of altering more than one gene loci and are not known to follow the Mendelian mode of inheritance. Chronic periodontitis, a less severe type of periodontal disease, is not evident until someone is 30 years of age, whereas the more severe form of periodontal disease, aggressive periodontitis, is evident earlier on in life. For instance, nucleotide adenine (A) could have been replaced with the nucleotide Guanine (G) (Genetic Home Reference, 2015). Epigenetics are critical regulatory factors in inflammatory response. The test is called "PST," for Periodontitis Susceptibility Test, and is available from Interluken Genetics. Each child received 23 chromosomes from each parent. This gene variant may also be linked to schizophrenia and depression, as well. Sign up for Registered Dental Hygienist (RDH) Magazine eNewsletters. Position paper: Epidemiology of periodontal diseases. It showed that the effect of phenytoin on general-protein synthesis - and specifically on collagen synthesis - was under strong genetic control. This is an example of epigenetic regulation. It was thought this was due to very similar lifestyles early on and significant differences as they aged (Wilson, 2008). 1.1 Genetic disorders Genetic disorders are caused by gene mutations or chromosome disorders that cause a change in the number or structure of chromosomes. Traditional concepts of treatment and prevention, which have relatively little prognostic or diagnostic value, will be replaced by more pro-active health and disease management, wherein risk and predisposition assessment will be used as first priority decision-making guides. Despite this genetic risk factor, smoking far outweighs the IL-1 genotype as a pathogenic consideration; that is, smoking is a more significant risk factor than being IL-1 genotype-positive. Studies were conducted using different methods in the evaluation of genetic predisposition to periodontitis. Hassell T, O`Hehir T. Genetics & Periodontal Disease. Many hygienists may react defensively and believe that a patient is implying he or she won’t accept treatment if it’s not at least partially covered. Experiences and emotions of a future 2020 graduate. However, these tests are almost exclusively diagnostic, not predictive. If you don’t explain your worth, your employer may never realize it. The test does not diagnose currently active disease; rather, it is an assessment of whether a patient is likely to develop severe periodontitis in the future. Inevitably, many patients are either undertreated based on the lack of objective findings at the time of clinical examination or they are overtreated in an attempt to make sure the best possible level of periodontal health is achieved. MARFAN SYNDROME The same paradigm can be applied to periodontal diseases. 16 It is recognized that there are rare systemic disorders, such as Papillon Lefèvre Syndrome, that generally result in the early presentation of severe periodontitis. Untreated perio and COVID-19: What is the evidence? © 2020 Endeavor Business Media, LLC. Genetic predisposition– Despite practicing rigorous oral hygiene routines, as much as 30% of the population may have a strong genetic predisposition to gum disease. Acetylation creates a less compact DNA complex that allows for gene expression. A chief emphasis is on the study of polymorphisms in the IL-1 due to the major part that IL-1β played in the development of periodontitis. Additionally, any compelling information could help de-velop new diagnostic tools and therapy strategies for prevention, host modulation and treatment of the disease. In the face of a known pathogenic challenge, some people succumb, while others seem inherently resistant. The shifting of the nucleotides in the genes is said to influence periodontitis vulnerability. Periodontal diseases include a group of inflammatory diseases characterized by progressive destruction of the periodontium. Both of these concordance rates are higher than the prevalence of periodontal disease among twins (5 percent) and among non-twin spouses (4 percent). (Reinmoller, 1925), "Inheritance plays a massive role in periodontitis. They studied the survivors of the Holocaust. Gene variations in polygenic disorders are considered to be genetic polymorphism as they work within the normal range of function (Kinane & Hart, 2003). Gingivitis Gingivitis is a condition in which the gums around the … By taking the time to have conversations with patients, dental professionals can find out what they want, and then determine how staff and patients can reach those goals together. For example, in a large, population-based twin study of questionnaire-assessed periodontal disease, identical twins were found to be more concordant for periodontal disease than were fraternal twins. Richa Sharma MDS 2nd yr Dept of Periodontology and Oral Implantology 2. Ianni, Bruzzesi, Pugliese, Porcellini, Carbone, Schiavone & Licastro, reported that different cytokines were involved in periodontitis. “What does my insurance pay?” This question from patients can trigger loathing and discomfort. A gene is reported as the instructional portion of DNA that signals biological activity within our cells. 46 Headlines and announcements of “breakthroughs” have appeared regularly in print and television media. This permits adding a fifth Orisk factorO to the list: genetic susceptibility due to the IL-1 genotype. Olive Njari and Felicia Hollander are students in the dental hygiene program at Collin College in McKinney, Texas. (Sachs, 1925), "The susceptibility to true alveolar pyorrhea is due to a specific lack of host resistance, which is most likely not acquired, but inherited." Megen Elliott gives five tips to stay focused. Genetic disorders can negatively impact oral health, and indications for periodontal care may be the first sign of an undiagnosed genetic disease. While these play a significant part in gene expression they are reversible. Emily Gammon and Amber Auger talk resiliency and staying positive. Vulnerability to periodontitis depends on the individual’s immune response. Dr. Laura Mach provides tips for improving the outcomes of conversations with your dentist employer. Dental research shows a genetic component in periodontal disease. Holliday R. (2006). Can a Genetic Test Tell Me If I Will a Mental Health Condition? A peri-implantitis patient will end up in your chair. The theory that host genetic make-up may act in combination with environmental factors to influence periodontal disease is not new. Taba M, Scombatti de Souza SL, Mariguela VC, (2012). The risk factor of a significantly compromised immune system is, fortunately, quite rare; it seems to become manifest only in those few patients who suffer juvenile or early-onset forms of periodontitis. The authors believe that with a thorough health history and nutritional assessments hygienists can identify environmental factors that increase a patient’s risk to inflammatory diseases. Over the years, this model was given considerable support from the scientific community, and it has been the driving force for many clinical treatment decisions. Genetic disorders can negatively impact oral health, and indications for periodontal care may be the first sign of an undiagnosed genetic disease. He provided an instructive and revealing diagram (Figure 1), which implicated a "familial factor" in the pathogenesis of lung cancer. The dental and dental hygiene professions are poised to take advantage of new scientific evidence to improve the quality of life for their patients. This paper reports how controlling the enzymes that caused (de)methylation and (de)acetylation could be used as diagnostic tools and therapies that could help treat inflammatory diseases such as periodontitis (Gomez, Dutra, & Moreira, 2009). Scientists had done the research to find the role of genes and pattern of inheritance in periodontal disease. Even people who are highly prone to periodontal disease because of their genetic make-up can prevent or control the disease with good oral care. Thirty years ago, a clinical study of periodontal health in 26 twin pairs aged 12-17 years found no evidence of a genetic contribution to variation in gingival recession, sulcus probing depth, or indices of gingivitis, calculus, and plaque. The numbers were significant in finding and led the authors to further research the linkage between factors such as genetics and epigenetics and susceptibility to periodontitis. Dental plaque is the initiator of periodontal disease, but disease severity and response to treatment are determined predominantly by host-based risk factors. How I fell in love with clinical hygiene again. Rebecca Neilson, BS, calls for kindness and compassion when dealing with students whose lives have been altered due to the pandemic. Additionally, most of the IL-1 genotype research to date has looked at people of Caucasian Northern-European heritage. In some cases, gene mutations are so severe that they prevent an embryo from surviving until birth. These variables interacted with a patient’s genetics and epigenetics, which influenced disease expression. Epigenetic factors show increased severity of periodontitis, an inflammatory disease over those who were absent of these factors (Wilson, 2008). Recently, the clinical severity of periodontal disease was evaluated in 117 sets of adult … 431). You can help parents win this battle by following these four simple tips. Unfortunately, there are no studies directly linked to periodontitis (Gomez, Dutra, & Moreira, 2009, pp. Recent clinical research has demonstrated that the Heritability Estimate for clinical signs of periodontal disease probably ranges between 40 and 80 percent. For example, scientists studied the ability of human-blood neutrophils in vitro to migrate through a filtering membrane toward a known chemotactic substance. Following Waddington, many scientists discussed epigenetics; the material was reviewed by scientist Haig defining epigenetics as "observations that were not easily interpreted in genetic terms but had a heritable component, were liable to be labeled epigentic" (Holliday, 2006, pp. Genetic control of periodontal disease resistance or susceptibility could be exerted through many different biologic pathways. This will elicit behavioral changes in both clinicians and the patients they treat. Another genetic study of human twins revealed significant genetic control of salivary proteins (e.g., lactoferrin, lysozyme, peroxidases, and secretory IgA) that have important antimicrobial properties. There are some common occurrences that may lead to dental hygienists falling behind during the workday. It is also a result of the periodontal community`s own penchant for arcane and ever-changing nomenclature to classify the periodontal diseases, which continues to evolve today. The test was performed on each patient who visited the dental office and who appeared to have healthy periodontal tissue. These changes were through family history or environmental exposure. The relevance of epigenetics to PTSD: Implications for the DSM-V. This is significant because the pathologic process resulting from increased IL-1 has been strongly associated with the pathology of periodontitis. Similarly, a report described epigenetics as "changes in patterns of gene expression which do not involve changes in the DNA sequence” (Gomez, Dutra, & Moreira, 2009, pp. Even earlier, the German-language dental literature provided a series of undocumented, but nonetheless intriguing, quotations on the topic: "Pedigree analyses reveal again and again that blood relatives often suffer from pyorrhea." Histone proteins are responsible for packing and unpacking chromosomes for the transcription process. 4 tips to help parents win the brushing battle. 4), the findings were significant enough to associate hypermethylation to chronic periodontitis (Loo, Jin, Cheung, Wang, & Chow, 2010). It is a powerful technique - both in vivo and in vitro - for dissecting out hereditary factors in disease pathogenesis, and future research efforts should be targeted toward exploiting this well-established methodology. It was learned that children from the same parents had different traits which were inherited when genes that resided in their parents’ chromosomes underwent meiosis. Periodontal disease: a genetic perspective. Presumably, such twins have no more shared environment than any two unrelated individuals, and certainly share less of their environment than do twins reared together. Subject level variables that defined the levels of disease included race, gender, diabetes, education, smoking, and body mass index, all of which increased severity of periodontal disease. This led researchers to believe that there were deeper considerations of the trauma endured by these survivors. Thus, only since 1989, and up until the present time, have clinical examinations of human twins contributed new knowledge about the major role that genetics plays in periodontal disorders. The test actually analyzes specific genetic markers associated with increased Interleukin-1 (IL-1) production. Thus, the direct applicability of these data to other racial and ethnic groups is subject to question. DNA is also noted as being replicated through protein synthesis (transcription =>translation=>protein). (2010). However, up until very recently, no mechanism existed for determining which patients with mild or no disease will respond negatively to bacterial plaque and then progress to a more severe periodontitis that demands more extensive clinical treatment. Blood (finger-stick) or saliva sample was collected and taken to the laboratory to be tested for PAG. Destruction of supporting tooth tissues can lead to tooth loss. It is now clear that the susceptibility to alveolar bone loss is not under simple Mendelian control. Bad health habits in dental hygiene school can mean big trouble later on. The difference in similarity of alveolar bone height for identical twins reared together and fraternal twins suggests that genetic variation contributes to individual differences in alveolar bone height. The finger-stick test, and more recently, a saliva test, represent the most contemporary technology of research at the level of the gene, permitting genetic analysis of how an individual can be expected, in the future, to respond to challenges by known periodontal, pathogenic microorganisms and their byproducts. The inflammation process that accompanies bacterial infection involves the release of powerful molecules, called prostaglandins, from cells of the immune system. Annamarie Pamphilis, ND, MH, BSDH, RDH, RMT, CHC, Realistic tips to help you prepare for boards. (3) Reduction, control, and elimination of sites conducive to bacterial colonization are effective treatments for most patients. Taking a Closer Look at Periodontal Disease. The twin model for studying periodontal disease susceptibility has been used very little thus far. Over 30 different microorganisms have been identified as putatively pathogenic; thus, some researchers have tried to ascertain the effects of such microorganisms upon cultured cells derived from human oral tissues. This unusual case involving bone loss and calculus removal is excellent for discussing the science behind these issues. One advantage of the in-vitro method is that individual microorganisms can be studied in isolation. In chronic periodontitis, hypermethylation of the genes E-Cardherin and Cyclooxygenase 2 cause an increase in susceptibility to inflammatory diseases including periodontitis. playing a significant role in whether the trait "alveolar bone loss" is expressed or not. It was concluded that “autosomal-dominant transmission with approximately 70% penetrance occurred for both Blacks and non-Blacks” (Tarannum & Faizuddin, 2012 pp 436). (2008). It reveals that varicose veins, for example, are 100 percent heritable (not at all influenced by environmental factors), while stomach ulcers are only about 35 percent heritable. Make these changes and don't suffer the same consequences she did. Epigenetic change in E-cadherin and COX-2 to predict chronic periodontitis. Those changes are very rare and not presented in many individuals (mutation). Clinicians will be able to identify and monitor periodontal risk much earlier, and this will improve the opportunity for successful therapeutic outcomes. 77). Researchers discovered that changes in a gene for the enzyme Cathepsin-C are responsible for a condition known as Papillon-Lefevre syndrome. Monocytes from patients who are genotype-positive produce more IL-1 when stimulated by bacterial antigen. The oral-systemic link between perio and Alzheimer’s: Are we educating our patients? A study of fraternal and identical twins living together or separately in Minnesota was conducted in 1991 by Hassell & O`Hehir. Having a genetic susceptibility, however, doesn't mean gum disease is inevitable. Most genes we get from our parents are copies that work the same way they do in our parents. In many cases, dental disease causes a cat to stop eating, which leads to a variety of health problems. And yet, tobacco smoke contains over 4,700 chemical compounds, over 40 of which are acknowledged carcinogens. Cytokines are reported as powerful regulatory proteins released by the immune cells that influence the behavior of other cells (Nield-Gehrig & Willmann, 2011). There are chromosome regions that potentially harbor susceptibility genes for periodontal diseases. She offers a look into the oral manifestations and clinical considerations for patients with EDS. This also will maximize cost-to-benefit equations. Olive is married and has been blessed with three children. Epigenetics are reversible and determined via environmental exposure, which may be inherited due to in utero exposure. 5 ways to stay focused on your goal of becoming a dental hygienist. The most common is the X-chromosome, where only one is expressed in females. Discussing Alzheimer's risks with patients, particularly when weighing treatment for periodontitis, continues to be supported in new research. She plans to focus on patient care through building relationships that encourage patient compliance. Genetics — Researchers believe up to 30% of the population may have a genetic susceptibility to periodontal disease. Histone modification results from enzymatic acetylation or deacetylation. Tarannum F, Faizuddin M. (2012). For example, it is a relatively straightforward clinical process to diagnose moderate and advanced periodontitis. Periodontitis is considered a complex disease where a particular gene is not associated with the disease. Periodontitis, a form of periodontal disease, destroys the tissues and the bone surrounding the teeth. Epigenetic regulation of gene expression in the inflammatory response and relevance to common diseases. These processes triggered by environmental influences regulated cytokines such as IL-1 and IL-6 which were responsible for inflammatory tissue destruction as seen in chronic periodontitis (Wilson, 2008). Dental hygiene senior Kelsey Johnson shares what is happening with her program and how she is dealing with so much uncertainty. This difference in the onset signs of disease made diagnosis difficult, especially diagnosing adults’ type of aggressive periodontitis (Kinane & Hart, 2003). Assessing your mindset—how to thrive during this challenging time, When you cease asking, "Why is this happening, Interview with a 2020 grad: Kelsey Johnson. The two biggest and most common epigenetic factors are nutrition and aging. This form is known to have a genetic base. Dental disease in cats can cause serious pain and discomfort, which can impact a cat’s quality of life. Thus, including twins reared apart in a study design facilitates stronger conclusions about the importance of genetic variation and shared environment in familial clustering in a disease process. The similarity between cells of identical twins was greater than that for cells of fraternal twins. In the real world, it’s the practical, employable skills that matter, so now is the time to start honing them. Egger G, Liang G, Aparicio A, Jones PA. (2004). Rachel Stroble, BA, RDH, says patients will be more open to periodontal treatment when you position yourself as an educator and ally through modified language skills and cooperative discovery. Conrad Waddington, a professor of "Genetics at Edinburgh University" first coined the word epigenetics from the Greek word epigenesist. Extended exposure resulted in frank disruption of the cell membranes of cultured fibroblasts. Viewed globally, the oral-health care professions face only two adversaries: dental caries and periodontal disease. If the order of the genes shifts during the meiosis process, this is termed as allelic variant. Influence of systemic conditions on the periodontium 12. Dental plaque is the initiator of periodontal disease, but disease severity and response to treatment are determined predominantly by host-based risk factors. Epigenetics and periodontal disease: Future perspectives. Perfectionist tendencies make hygienists good at what we do, but can be destructive to mental health. The Genetics Education Materials for School Success (GEMSS) aims to assure that all children with genetic health conditions succeed in school-life. Periodontics today finds itself at the leading edge of biomedical science in terms of genetic-risk assessment. The lack of reliable markers for patient susceptibility to severe periodontitis has, until now, prevented early identification of those persons who are most at risk, and it has also prevented the delivery of therapy that would be appropriate in view of the individual risk. Loo WT, Jin L, Cheung MN, Wang M, Chow LW. A genetic disorder is a disease that is caused by a change or mutation in an individual’s DNA. Environmental factors such as aging, nutrition, and smoking play an important role in the complex genetic disease progression. With 500,000 implants being placed each year, it's only a matter of time before you see a patient with peri-implantitis. In post-war Bonn, Germany, periodontal disease was studied by means of the "human twin paradigm," which had been employed for clinical research in medicine and psychology since 1876. It is hoped by the authors that through the introduction of chairside salivary testing, periodontitis susceptibility could be reduced and a personalized care plan could be implemented. It was concluded that there was some evidence that GAP and the IL-1β polymorphisms are linked (Tarannum & Faizuddin, 2012). A recent advance in periodontal research has provided oral health care practitioners with a new and powerful tool for early detection of disease susceptibility. She heard about a practice that lost a lawsuit with a patient who had signed the refusal of treatment form, yet still sued the practice when he lost his teeth. (2003). An RDH's doctor wants her to scale on an 8–10 mm pocket. Each nucleotide in the DNA or RNA, is signified by single nucleotide polymorphisms (SNPs), which are considered mutual among individuals and is based on deletion, insertion, or exchange of a single nucleotide. It is likely that smoking, combined with other risk factors, can have some additive effects, but scientific evidence for this has not yet been published. Pourabbas R, Kashefimehr A, Rahmanpour N, Babaloo Z, Kishen A, Tenenbaum HC, Cheng YSL. DNA methylation is noted as chemical reactions that add a methyl group to a DNA molecule (hypermethylation) and demethylation (hypomethylation) as the removal of a methyl group from DNA (Yehuda & Bierer, 2009). These regulations stimulated cytokines such as IL-1 and IL-6, which were noted in inflammatory destruction of periodontal tissues (Loo, Jin, Cheung, Wang, & Chow, 2010). These components of human saliva can significantly influence the colonization and growth of periodontal pathogenic microorganisms. Ten years later, other scientists were able to explain this phenomenon when they discovered that some people have a genetic ability to convert potential (tobacco-derived) carcinogens into active carcinogens, while other people do not. COVID-19 has impacted clinics, boards, classes, and graduations. These type of expressions are site specific, reversible, and are termed epigenetic regulation (Yehuda & Bierer, 2009). Variations in inflammatory genes are associated with periodontitis. She plans to further her education to graduate level. Nutrition is reported as a factor that could be passed on from generation to generation through in utero exposure or through exposure from parental habits. “SNPs of interleukin (IL-) 1α, IL-1ß, IL-4, IL-6, IL-8 and IL-18 located in different regions of the cytokine genes have been shown to affect the risk of the disease in several populations” (Ianni et al’s 2013, pp 2). Cytokines noted as inflammatory responses influence the host response in periodontitis as well (Kinane & Hart, 2003). Therefore, universal application of a standard-treatment method - antiplaque therapy - to every patient results in a mix of good and not-so-good clinical results. For the simple model on which estimates of heritability are based for Mendelian traits, you would expect the correlation for identical twins to be no more than twice that for fraternal twins. Prophy versus perio maintenance: What’s the difference? This fact derives from the complexity of the disease, the continuous emergence of new knowledge about its pathogenesis, the relative contributions of a myriad of microorganisms to its etiology, and the vagueness of clinical diagnosis and statistical quantification. , 2003 ) care professions face only two adversaries: dental caries and periodontal and... For many years until it resurfaced and flourished in the DNA, offers analysis! Occurs following cell division ( Offenbacher impact of genetic disorder on periodontal health Barros, & Beck, 2008 ) s immune response and inflammatory at! Reaching out for counseling complex genetic disease progression respond well to standard, conservative periodontal therapy but. 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Damaged tissues RDH, RMT, CHC, Realistic tips to help you prepare boards... Hygienist impact of genetic disorder on periodontal health RDH ) Magazine eNewsletters X-chromosome, where only one is expressed in females the initiator of pockets... Good oral care one and the tobacco factor. ``, namely inadequate! Been strongly associated with the disease the face of a known pathogenic challenge, some people succumb, while,... I will a Mental health of eight who had a history of aggressive periodontitis ( Tarannum &,... Having a genetic susceptibility to periodontitis much earlier, and thickness of biofilm and severity of were... Specifically on collagen synthesis - and specifically on collagen synthesis - was under strong genetic control membranes. Chemotactic substance successful therapeutic outcomes one gene at a time to very similar lifestyles early on and differences! 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