Predicting periodontal disease through technology

Inflammatory periodontitis is a disease which affects the the tissues that surround and support the teeth. It involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth. The disease affects 50% of adults globally, costs the UK economy £2.78 billion and also impacts negatively upon general health. Severe disease is can lead to other health problems such as poor glucose control and cardio-renal outcomes in diabetes and atherogenic vascular disease.  

While periodontal therapy improves diabetes control and outcomes, periodontitis is a silent disease - often diagnosed late when the destructive changes are irreversible. Diagnostically accurate biomarkers are therefore needed to facilitate screening in primary dental and medical practices. Biomarkers are indicators of a biological state or condition, and are often used to examine biological or pathogenic processes or responses to therapeutic interventions.

The researchers began by examining the composition of fluid from gums called gingival crevicular fluid (GCF), which led to the development of several measurement methodologies and assays, enabling exploration of disease mechanisms and novel therapies.

Development of early diagnostic tests and treatment outcome measures required the establishment of highly sensitive assays capable of detecting miniscule levels of biomarkers in large volumes GCF. Several tests for GCF analysis were developed and applied to the study of disease processes. The biomarkers for GCF were shown to be a valid indicator of gum and periodontal health and have been adopted for clinical trials of new oral healthcare products.

The research group also looked at analysis of saliva as a diagnostic fluid using novel methods of saliva collection and delivery to analytical devices. Using saliva chemistry, we developed a test for nicotine using patented technology and demonstrated its efficacy in smoking cessation in a randomised controlled trial in primary dental care practice, where it led to 23% quit rates versus 7% for standard smoking cessation programs.

 Given recent evidence that periodontitis is a risk factor for rheumatoid arthritis (RA), the group have gone on to develop methods to identify new biomarkers of RA in saliva proteins and are working with Philips on further exploitation.

This research has generated substantial commercial impact via additional investment of several millions of pounds in R&D by 3 major companies since 2008, and is driving these organisations in developing and evaluating new/improved oral care products. It has also led to the formation of two UK spinout companies: one to design and successfully market an innovative online biofeedback technology into high street dental practices; and the other to design and market a low cost near patient test for nicotine in saliva used in smoking cessation and identification of exposure.

Building on this research and his related expertise, Professor Chapple and his team have collaborated with Unilever, Philips and Mars, helping them create new business areas which has led to their related investment in R&D.  Over 30 scientific employees are now involved in this work within these companies and many more marketing staff.

This successful research portfolio has stimulated a multi-disciplinary saliva biobank for biomarker discovery in Renal, Rheumatology, Respiratory and Diabetes Medicine, at Birmingham’s Inflammation Research Facility. Over 800 saliva samples are biobanked and thousands more are planned. The benefits of the saliva diagnostic program have convinced the local medical research community to collect saliva from all chronic disease patient cohorts.

If this has sparked an interest in studying a course in the College of Medical and Dental Sciences, you can find a list of the of Undergraduate, Postgraduate and Doctoral research opportunities on offer from the College:

• Undergraduate

• Postgraduate

• Doctoral research