In the UK, some level of irreversible periodontitis affects almost half of all adults.[i] Its high prevalence and association with over 50 systemic inflammatory disorders and comorbidities makes it an essential disease to combat.[ii]
One promising area for tackling periodontitis and its symptoms is in immunotherapy. Recent studies have sought to deliver immune-modulating compounds to reduce symptoms of the oral disease, such as bone loss, and ultimately prevent it.[iii] Whilst the research continues gaining traction, dental practitioners that understand the role of the immune system can broaden the ways they can help patients affected by periodontitis.
Braving bone loss
The symptoms of periodontitis are numerous and well known: bleeding gingivae, swollen gingivae, halitosis and loosened teeth.[iv] For 70-80% of patients with periodontitis, regular hygiene appointments with a dental professional can reduce the symptoms and prevent disease development, but, when left unchecked, periodontitis can also trigger resorption in the alveolar bone.iii This occurs when harmful bacteria in the oral cavity activates the body’s immune system, sending white blood cells streaming into the affected area and causing inflammation. Chronic inflammation leads to the progressive destruction of the gingival connective tissue and collagen, causing bone loss. A reduction in the alveolar bone can have a serious dental impact, weakening the supporting structures of the teeth and leading to tooth loss. This contributes to many health and wellness issues, such as:
- Changed facial aesthetics
- Increased patient self-consciousness in social situations
- Limited mastication and malnutrition
- Lowered quality of life, which may lead to low self-esteem and depression[v]
The lack of successful therapy towards alveolar bone loss demands a solution, and immunotherapy is showing potential as an answer. For studying the interactions between microbes and the immune system, the oral cavity is more accessible than the gut and lungs and can provide more answers. A recent study discerned that delivering immune-modulating microparticles directly to the gingivae inhibited bone loss and accelerated bone repair. By harnessing the immune system, the composition of bacteria can be shifted, reducing its harmful effects and preventing periodontal disease.iii To do this, macrophages must be utilised.
Managing macrophages
Macrophages, the white blood cells that kill microorganisms, are crucial for preventing alveolar bone loss: macrophage levels rise from 1.4 to 20.9% in unhealthy periodontal tissue.[vi] There are two key types: M1 and M2. The former is activated by pathogen invasion to defend the body and are inflammatory, aggravating periodontitis and promoting bone loss. M2 is anti-inflammatory and is integral for wound healing and tissue repair.[vii] By treating M1 white blood cells with the cytokine CCL2, they can be shifted to become M2 type.iii Or, theoretically, M2 injections into periodontal tissue could suppress osteoclast activity.vi When paired with a consistent oral hygiene routine, an increase in anti-inflammatory activity can prevent bone loss and treat periodontitis.
Dietary discoveries
As research into immunotherapy as a treatment for periodontitis continues, practitioners can get ahead by recommending ways of increasing M2 secretion to their patients. Diet is one key way to do this – Vitamins A and D control macrophage functions. Enjoying a diet rich in Vitamin A foods, such as carrots, watermelons, chicken, beef and butter, is vital for many health benefits, as a deficiency in Vitamin A can lead to a systemic proinflammatory state.[viii] Similarly, Vitamin D foods – oily fish, red meat, egg yolks, breakfast cereals – suppress the production of proinflammatory cytokines.[ix] In the non-summer months or for patients who do not see much sunlight, it is harder for the body to get Vitamin D, so these food types or supplements can provide all-round health benefits. Inflammatory foods, such as processed meats or carbonated drinks, should be avoided to reduce M1 prevalence in the oral cavity.
Clean, clean, clean!
Clean, clean, clean!Along with a balanced, anti-inflammatory diet, practitioners must recommend daily interdental cleaning to patients at-risk of periodontitis. To help achieve a superb standard of oral hygiene, recommend the FLEXI range of interdental brush from TANDEX. 11 different sizes ensure patients are able to reach all the areas where a traditional toothbrush struggles, cleaning the hidden tooth surfaces and massaging the gingivae. When used with the PREVENT Gel, from TANDEX, interdental cleaning gets an antibacterial boost for maximum protection against periodontitis.
Chronic periodontitis is a major disruptor in a patient’s quality of life. Loss of the alveolar bone can be devastating, and immunotherapy may be a future solution to preventing this. Until then, practitioners can aid vulnerable patients by encouraging anti-inflammatory diets and maintaining a consistent oral hygiene routine.
For more information on Tandex’s range of products,
visit https://tandex.dk/
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https://www.cts-dental.com/
Author Jacob Watwood
[i] GOV.UK (2021). Chapter 5: Periodontal diseases. [online] GOV.UK. Available at: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-5-periodontal-diseases.
[ii] Pai, S.I., Matheus, H.R. and Guastaldi, F.P.S. (2023). Effects of periodontitis on cancer outcomes in the era of immunotherapy. The Lancet. Healthy Longevity, [online] 4(4), pp.e166–e175. doi:https://doi.org/10.1016/S2666-7568(23)00021-1.
[iii] ScienceDaily. (2024). Immunotherapy for gum disease? Study in mice shows promise. [online] Available at: https://www.sciencedaily.com/releases/2024/09/240930160200.htm.
[iv] NHS (2018). Gum disease. [online] nhs.uk. Available at: https://www.nhs.uk/conditions/gum-disease/.
[v] Louis, P.J. (2010). Vertical Ridge Augmentation Using Titanium Mesh. Oral and Maxillofacial Surgery Clinics of North America, 22(3), pp.353–368. doi:https://doi.org/10.1016/j.coms.2010.04.005.
[vi] Peng, S., Fu, H., Li, R., Li, H., Wang, S., Li, B. and Sun, J. (2024). A new direction in periodontitis treatment: biomaterial-mediated macrophage immunotherapy. Journal of Nanobiotechnology, 22(1). doi:https://doi.org/10.1186/s12951-024-02592-4.
[vii] Guo, L. (2022). Macrophages: What Are They, Different Types, Function, and More | Osmosis. [online] www.osmosis.org. Available at: https://www.osmosis.org/answers/macrophages.
[viii] Atli Arnarson, PhD (2017). 20 Foods That Are High in Vitamin A. [online] Healthline. Available at: https://www.healthline.com/nutrition/foods-high-in-vitamin-a.
[ix] Caprara, G., Allavena, P. and Erreni, M. (2020). Intestinal Macrophages at the Crossroad between Diet, Inflammation, and Cancer. International Journal of Molecular Sciences, 21(14), p.4825. doi:https://doi.org/10.3390/ijms21144825.
