Periodontitis, or severe gingivitis, is a common disease that is estimated to affect about 20-50% of the global population – often without any symptoms at all. Now, for the first time, a Finnish study has produced encouraging results in identifying young people at risk of the  disease.

It is estimated that around 10% of young people in Finland have an onset of periodontal disease, but the susceptibility remains throughout life. The incidence of the disease increases significantly between the ages of 20 and 40.

“Therefore, identification of patients at risk should take place at an early age, preferably under the age of 20 when the onset and progression of this dental adhesive tissue disease can still be influenced,” says Ismo T. Räisänen, DDS, PhD, MSc(tech) from the University of Helsinki.

Räisänen has been part of a Finnish research team that has been actively searching for years for ways to overcome the serious gum disease, periodontitis, using modern methods of diagnosis and treatment.

A major focus of research has been the so-called immunological rapid test for active matrix metalloproteinase-8 (aMMP-8) developed by Professor Timo Sorsa of the Department of Oral and Maxillofacial Diseases at the University of Helsinki. It can be used to detect whether a periodontal breakdown of gum tissue is underway in a person's gum pockets even before it can be seen visually.

The effect of antibacterial photodynamic therapy (aPDT) in the prevention and treatment of gum infections including periodontitis and peri-implantitis has also been extensively studied and has also produced a large body of positive clinical evidence.

The Lumoral method, which is based on aPDT light therapy, hampers plaque formation and significantly reduces the amount of periodontal bacteria in the mouth. Elderly people, for example, are particularly well suited to the teeth cleaning method's user profile, as optimal oral self-care is critical in this age group. 

Dr Räisänen's recent thesis Risk factors and active matrix metalloproteinase-8 (aMMP-8) diagnostics for initial periodontitis in adolescents provides further confirmation of the usefulness of the aMMP-8 mouthrinse point-of-care (PoC) test for the identification of initial periodontitis in adolescents. Among other things, the study found that while saliva and mouthrinse are both useful in aMMP-8 diagnostics, mouthrinse appears to be more accurate than saliva.

The aMMP-8 test can be used to help assess the risk of the onset and progression of periodontitis. The aMMP-8 test can also be used to monitor the effectiveness of periodontal treatment by a professional.

“Based on the results of the thesis, it would be useful for every young person to have an aMMP-8 test done at least once before the age of 20, especially if they have other risk factors for periodontal disease.”

Test result in minutes

MMP-8 is an enzyme produced mainly by neutrophils, the most common white blood cells in humans. It plays a key role in inflammatory processes in the body. However, in the case of periodontitis, the inflammatory process of the body results in the activation of the MMP-8 (aMMP-8) enzyme and the breakdown of periodontal tissue that helps keep teeth in place.

The five-minute test that can help measure the risk of active periodontal adhesion tissue loss and its progression helps complement the diagnosis, outcome monitoring and maintenance treatment of periodontitis and peri-implantitis.

“At the same time, it enables early referral of young people at risk of developing severe gum disease for further investigation and treatment,” Räisänen explains.

Early signs of periodontal disease include red and bleeding gums and halitosis. Once established, the disease is a 'tenacious' companion that progresses if not treated carefully.

The cornerstone of treating gum disease is good oral hygiene, which requires professional help, as the oral biofilm that has hardened into tartar must first be removed from the tooth surface and gum pockets. This is followed by cleaning of the teeth through careful oral hygiene to prevent the formation of new tartar in the gum pockets.

According to the National Institute for Health and Welfare (THL), more and more people in Finland brush their teeth at least twice a day. However, there are still gaps in oral self-care. Although brushing teeth and interdental spaces is an effective way to clean teeth, studies show that brushing leaves up to half of the plaque on the tooth surface.

Careful prevention pays off

Räisänen stresses that prevention and timely treatment of periodontal disease are important both for the health of individuals and economic well-being of society.

The treatment of periodontitis, especially severe periodontitis, is expensive and ties up a lot of resources. It is also important to be aware that the harmful effects of periodontal disease are not limited to the mouth and teeth. It is linked to a number of underlying diseases such as diabetes, cardiovascular disease, pulmonary disease, various cancers and also to complications of COVID-19. According to one scientific study, a first heart attack is 30% more common in people with periodontal disease than in healthy people of the same age.

“Now is the time to start investing in oral disease prevention as public health care resources are already stretched. Early detection and treatment of periodontal disease is cost-effective at all ages. Good oral health is part of overall health and improves patients' quality of life,” says Anna Maria Heikkinen, Professor of Clinical Dentistry, Associate Professor of Clinical Periodontology, University of Tampere, Specialist Dentist in Healthcare and Clinical Dentistry.

According to Heikkinen, identifying young people at risk of periodontal disease can reduce over- and under-treatment. Individual risk factors should be taken into account and a oral home care plan should be drawn up for each individual on this basis, using appropriate dental care tools.

“This is cost-effective and can save money in the future by reducing the cost of treating adult periodontitis. Investing in young people is an investment in the future!”

Heikkinen says that, as research leader, she will launch a follow-up study in autumn 2023 to assess the oral health of young people, combining aMMP-8 diagnostics with antibacterial Lumoral treatment. The aim is to gain a broader understanding of how aPDT treatment, when used regularly, affects the oral health of adolescents.

Recent results in the adult population have been encouraging and more are expected later this year on the use of aPDT (Lumoral) in the treatment of oral diseases.

“We need information on how individualised prevention of oral diseases, both periodontal disease and tooth decay, can be improved and targeted with new methods in addition to standard home self-care in adolescents. The benefits of new innovations need to be examined through research before they are more widely adopted,” says Heikkinen.

In the adult population, there have recently been encouraging results on the use of aPDT (Lumoral therapy) in the treatment of oral diseases.

“Therefore, it is justified to investigate the benefits of aPDT in the prevention and treatment of incipient periodontitis and, why not, caries as well in adolescents. The impact will be evaluated in addition to and in support of normal self-care activities such as brushing teeth, cleaning between teeth and regular visits to the dentist and oral hygienist,” concludes Räisänen.

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International Gum Health Day celebrated on 12 May 2023

Gum Health Day, promoted by the European Federation of Periodontology (EFP), the umbrella organisation for periodontology in Europe, is celebrated annually on 12 May.

The aim of this anniversary, which highlights the importance of oral health, is to raise awareness among health professionals and the general public of the need for prevention, early diagnosis and treatment of periodontal and peri-implant diseases, and to highlight the importance of periodontal health as part of good general health.

The slogan for this year's Health Day is "Healthy gums look good. Protect them!". This is to highlight the importance of periodontal health as part of good general health, without forgetting the importance of aesthetics.

The link between oral and general health is widely understood, but is this reflected in Finland's health care system and people's oral health? To mark World Health Day, Jukka Meurman, Professor Emeritus of Oral Infectious Diseases, and Tommi Pätilä, cardiac and transplant surgeon at the New Children's Hospital of HUS, reflect on the issue from the perspective of oral health.

World Health Day, launched by the World Health Organisation (WHO), is celebrated worldwide on April 7 to raise awareness of various health concerns. This year's theme – Health for All – focuses on health equity. In other words, the state in which everyone has a fair and just opportunity to attain their highest level of health. 

What about health equity in Finland? Does everyone have equal opportunities to attain their highest level of health in Finland, a country ranked the world's happiest for the sixth year in a row in 2023?

Health inequality is a national challenge also in Finland. Also, in terms of oral health equity. Although the health of Finns has improved considerably over the last decades, according to indicators such as morbidity, work capacity, and mortality, poverty and exclusion are also reflected in Finns' teeth and oral health.

Poor socio-economic status and low education and income levels have a negative impact on oral health. The Finnish Dental Society Apollonia has warned that there is still a lack of comprehensive and adequate oral health care services for the adult population. The poor oral health situation in Finland is also reflected in children.

According to Professor Jukka Meurman, the lack of resources for public oral health care is also directly reflected in the quality of oral health care for people with physical disabilities and, thus, in the prevalence of oral diseases. There is also an urgent need for more staff trained in oral health care for people with disabilities.

Cross-border cooperation for more efficient use of health resources

Oral health is directly linked to a person's overall health and well-being. However, oral health problems are challenging because they are often asymptomatic and may go unnoticed. Undetected chronic oral infections such as caries and periodontitis can contribute to the development of serious diseases such as cardiovascular disease, diabetes, and cancer and, for example, increase the risk of premature birth in expectant mothers (1). 

- Although the link between oral health and general health has been discussed since ancient times, much remains to be done, especially among the public. The issue is becoming well understood in the medical profession, but there is still a need to add dental education to medical curricula and vice versa, says Meurman.

According to the WHO, periodontal disease is estimated to affect around 19% of the world's adult population. This means more than one billion cases worldwide.

In Finland, it is estimated that up to two out of three people over 30 suffer from periodontitis. The disease is even more common in people with diabetes. If left untreated, persistent gum disease can put people at risk of tooth loss - but it is also linked to severe heart events. 

According to a study, the first heart attack is 30% more common in people with periodontal disease than in healthy people of the same age (2).

According to Meurman, many doctors in Finland check the oral health status of their patients in their practices and refer them for further treatment if necessary. Diabetes, for example, is a good example of a disease where the importance of latent inflammation is already widely understood.

Meurman further believes that cooperation between doctors and oral health professionals in Finland should be significantly increased, even during basic training. This would make sharing the workload and managing the health workforce easier. Finland should also consider offering new training programs to ease the shortage of resources in the dental healthcare sector.

- While current dental training takes 5-6 years, an "oral health therapist" training course would only take about 2.5 years, Meurman suggests.

The ideal situation would be for dental training to be similar to specialist training in, say, ophthalmology. Moreover, many practical dental procedures could be carried out by specialists with a university of applied sciences degree.

Meurman admits that such a situation has not yet been fully achieved anywhere in the world. However, in countries such as Singapore and New Zealand, professionals receiving Oral Health Therapist training have, for many years, already eased the workload of dentists. Oral Health Therapists examine dental decay and gum disease and provide routine dental treatments such as teeth cleaning, polishing, teeth extraction and treatment for patients under the prescription of dentists.

Preventive oral care brings benefits to individuals and society

Tommi Pätilä, a cardiac and transplant surgeon at the New Children's Hospital at HUS, believes that oral health is not sufficiently taken into account for patients coming to specialized care. The problem is the frequent lack of time. In specialized care, it is easy to think that a dentist can examine the patient's mouth in due course.

Oral health should always be considered at the basic examination stage for hospital patients. The information should be regularly recorded in the medical records – just like blood pressure values are routinely monitored, says Pätilä. 

More resources for oral health care would be necessary for Finland. It would also be economically worthwhile for society, as it would help prevent the onset of many general diseases.

According to Meurman, preventive health care, including using the antibacterial Lumoral method to improve oral hygiene, will quickly pay for itself.

Pätilä stresses that investing in oral health care and prevention would reduce the development of chronic diseases and the exacerbation of those that have already developed. This would be particularly important for people with cardiovascular disease, diabetes, and rheumatic diseases.

- Preventive oral health care brings significant savings to society. This applies not only to dental care but to the entire healthcare system. Lumoral supports regular mechanical dental hygiene and helps to achieve gum health and prevent inflammation when regular dental hygiene is not enough, says Pätilä.

References:

1) Jacobsson B, Kacerovsky M, Menon R, Musilova I, Radochova V, Slezak R, Stepan M, Vescicik P (2019) ‘Association between periodontal disease and preterm prebalor rupture of membranes'. Journal of Clinical Periodontology.

2) Rydén L, Buhlin K, Ekstrand E, de Faire U, Gustafsson A, Holmer J, Kjellström B, Lindahl B, Norhammar A, Nygren Å, Näsman P, Rathnayake N, Svenungsson E, Klinge B: Periodontitis Increases the Risk of a First Myocardial Infarction. A Report From the PAROKRANK Study. 13.1.2016 Circulation. 2016;133:576–583 

Finnish health technology group Koite Health showcased its Lumoral method at the Igienista Dentale 3.0 (Dental Hygienist 3.0) congress held in Italy, Rome, on March 4, 2023. At the Lumoral stand company consultant Gianfranco Panzironi explained to a highly interested group of Italian and Spanish dental professionals how the antibacterial Lumoral method is designed to enhance oral home care for the prevention and treatment of gum diseases and dental caries.

As in other parts of the world, oral diseases are also common in Italy. Although awareness of periodontal disease has increased in the last years, about 60% of the Italian population suffers from gingivitis and periodontitis. Thus, there is a need to improve the dental hygiene habits of the people living in the country.

–The high number of dental implants placed in the mouths of Italians increases the risk of peri-implantitis because maintaining good oral hygiene continues to be problematic for patients. Regular dental hygiene sessions associated with antimicrobial photodynamic therapy fight and prevent oral diseases, Italian dental hygienist professional and Lumoral consultant Gianfranco Panzironi notes.

Panzironi, what did the dental experts visiting the Lumoral stand think about Lumoral?

– The Lumoral method has been a big surprise for everyone! As professionals, we are familiar with antibacterial photodynamic therapy and its benefits, but until now, we have only seen such technology used in dental clinics. Carrying home this kind of treatment is cutting edge in oral hygiene.

What is your personal view on Lumoral – How did you learn about the method?

– During my visit to IDS Cologne in September 2021, I saw the dual-light device and some green tablets on the desk of the Lumoral stand. Lumoral caught my eye immediately at the International Dental Show! As I had already used such technology in non-surgical periodontal therapy, I immediately understood the indications of using such an excellent tool. Furthermore, I was impressed by the highly professional and kind Lumoral staff I met at that congress. They offered me complete and competent information about the Lumoral method.

After being introduced to Lumoral, Panzironi wrote a scientific paper titled "Home photodynamic therapy as a means of prevention for biofilm control." In this article, he explores the role of dental plaque in causing oral problems and the benefits of Lumoral in preventing oral problems.

– Prevention is the pillar against oral diseases, and compliance with correct oral hygiene techniques is essential to preserve the normal microbiome and maintain the health of the oral cavity. Among the new technologies that allow the patient to control the biofilm comfortably and effectively, a device for the home application of antibacterial photodynamic therapy stands out, Panzironi explains.

Italy is an important market for Lumoral. Thus, the Igienista Dentale 3.0 congress was an important event for the company to attend.

– Koite Health aims to expand to some of the largest nations in the European Union as fast as possible. This way we can offer our European customers access to better oral hygiene. Through our expansion we seek to give patients who suffer from periodontitis a chance to stop the progression of the disease and to help tackle the ever-growing problem of peri-implantitis, notes Koite Health's Chief Commercial Officer Tero Pasanen.

–About 150 colleagues came to the Igienista Dentale 3.0 congress from different cities in Italy and Spain. The atmosphere was very friendly, because these are occasions for us to meet colleagues and share ideas and experiences about our profession. We had an exciting day at the event that will be remembered! concludes Panzironi.