Development of Predictive Technologies for Periodontal Disease

Inflammatory periodontitis is a complex disease affecting 50% of adults globally. It costs the UK economy £2.8billion and has health impacts beyond just dental issues, particularly in diabetes and heart disease. 
Research in the University of Birmingham led by Prof Iain Chapple has partnered with many major global industry leaders – such as Unilever, Philips and Mars – helping them to trial new products for diagnosis. In addition, it has directly led to smaller companies launching innovative online risk and disease assessment technology for high street dental practices, as well as low cost tests used to help patients with smoking cessation.

Duration: 5.11 mins


Professor Iain Chapple, Professor of Periodontolgy and Consultant in Restorative Dentistry, College of Medical and Dental Sciences


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 [C… - 0:03:25] 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.

End of recording