New aspects in periodontal diagnostics

Tatsuji Nishihara, D. D. S., Ph. D. Kyushu Dental University

Contents 1. Pathogenesis of periodontal diseases

2. Systemic infectious diseases mediated by 3. peraiodontopathic bacteria 4. Increasing importance of oral infection as a major disease of elderly citizen in medical and dental areas 4. New aspects in periodontal diagnostics

Self-introduction

Tatsuji Nishihara, D.D.S., Ph.D. Present Status: Chairman and President Emeritus Professor Kyushu Dental University E-mail: tatsujin@kyu-dent.ac.jp

Education: 1975-1981

School of Dentistry, Kyushu Dental College, Kitakyushu, Japan. Received D.D.S.

1982-1986 Graduate School, School of Dentistry, Tokyo Medical and

Dental University, Tokyo, Japan. Received Ph.D. for a thesis entitled “Immunobiological properties and chemical compositions of cellular and extracellular endotoxic substances from Actinobacillus actinomycetemcomitans”

Employment (Tokyo) 1986-1990

Researcher, Department of Dental Research, National Institute of Health, Tokyo 1990-1992

Senior Researcher, Department of Dental Research, National Institute of Health, Tokyo 1990-1992

Postdoctoral fellow at the Department of Medicine, Division of Endocrinology and Metabolism, The University of Texas Health Science Center at San Antonio, Texas, USA working with Dr. Gregory R. Mundy. 1992-1993

Senior Researcher, Laboratory of Periodontology, Department of Oral Science, National Institute of Health, Tokyo 1993-1997 Laboratory Chief, Laboratory of Periodontology, Department of Oral Science, National Institute of Health, Tokyo

1997-1999 Laboratory Chief, Laboratory of Periodontology, Department of Oral

Science, National Institute of Infectious Diseases, Tokyo Employment (Kitakyushu) 1999-2004

Chairman and Professor Department of Oral Microbiology Kyushu Dental College 2004-present

Chairman and Professor, Department of Health Promotion, Division of Infections and Molecular Biology Kyushu Dental College 2006-2012

Dean, School of Dentistry, Kyushu Dental College 2012-2013 Chairman and President, Kyushu Dental College

2012-present Chairman and President, Kyushu Dental University

Pathogenesis of periodontal diseases

Healthy periodontal tissue

Periodontal tissue with gingivitis

Periodontal tissue with periodotitis

Periodontal tissue with juvenile preiodontitis

Radiograph of patient with juvenile periodontitis

PAGE & KORNMAN et al. Periodontology 2000. 14, 9-11, 1997

Nishihara et al. Periodontology 2000. 36, 14-26, 2004

Periodontopathic bacteria

Porphyromonas gingivalis Treponema denticola Tannerella forsythia Aggregatibacter actinomycetemcomitans Prevotella intermedia

Peridontopathic bacterium of

juvenile periodontitis

Periodontal tissue with juvenile preiodontitis

3-D computed tomography

Cardiac infarction mediated by

periodontopathic bacteria

Periodontal tissue

Periodontal diseases

Internal organs

General disorders

Destruction of periodontal tissues Loss of alveolar bone

Systemic malfunction

Leukotoxin Cytolethal Distending toxin Lipopolysaccharide Capsular polysaccharide

＜Virulence factors＞

Aggregatebacter actinomycetemcomitans

Nishihara et al. Periodontology 2000. 36, 14-26, 2004

CYTOKINES Inflammatory

mediators

The present and future states of periodontal research from the

standpoint of periodontal medicine

It is very important to note the standpoint of “Host-parasite

interaction”

Tissue destruction

55～72㎠

Tissue destruction of periodontium of patients with periodontitis

atheroma formation

periodontitis

coronary artery

Relation between periodontitis and arteriosclerosis

inflammatory factor

（LPS, cytokine, etc）

circulation

Inflammatory cell ↑

adhesion molecule ↑

chemokine, etc ↑

coronary artery

periodontopathic bacteria ・P. gingivalis ・A. actinomycetemcomitans

Periodotitis and cardiac infarction

Genetic factor Age Adiposity Hypertention

Acute phase Chronic phase

Increased level of fibrinogen NSAIDs

Abnormal platelet Exercise

NSAIDs Stress

Stress Dyslipdemia

Bacterial infection Smoking

（platelet aggregation +） Gram (-) bacterial infection

Thrombosis Atherosclerosis

Coronary obstruction・Cardiac infarction

P. gingivalis and S.sanguinis have high levels of activity

Periodontopathic agents are well known to be Gram-negative bacteria

Increasing importance of oral infection as a major

disease of elderly citizen in medical and dental areas

Aspiration pneumonia induced by periodontal diseases

Periodontopathic bacteria Oral resident bacterial flora

Air passage

Bronchitis induced by oral bacteria

Pneumonia Mechanism of spiration pneumonia induction by oral microorganisms

Swallowing function

Respiratory passage

Epiglottis

Esophagus

Periodonotopathic bacteria were detected from the patients with aspiration pneumonia

It is well known that aspiration pneumonia

is induced by oral bacteria and

swallowing disfunction

Opportunistic bacteria were also detected from the patients with aspiration pneumonia

It is well known that aspiration pneumonia

is induced by oral bacteria and

swallowing disfunction

The change of population pyramid (1930 - 2055)

male female

Population (x 10k)

age

NIPSSR

The population of 65 years old or more

Kita-kyushu City > All Japan > All Fukuoka Prefecture

(past, current and future)

2008

Population aging rate

2005 2010 2015 2020 2025 Kita-Kyushu

City 22.3% 25.3% 29.2% 31.6% 32.5%

Fukuoka Prefecture 19.9% 22.4% 26.1% 28.8% 30.1%

Japan 20.2% 23.1% 26.9% 29.2% 30.5%

Collaborative Education Between Dentistry and Engineering

Promote Life Science Education

Developing industry-university

collaboration

Dentistry Technology

Aging society with a falling birth rate

Dental education Periodontal disease, Oral health science

Manufacturing Technology

Enhancement of QOL

Purpose of this project

• Coorperate four universities having different specialities in Kitakyushu region

• Develop specialists with wider vision • Promote local revitalization • Mutual complement with specialties such as

medicine, health care and engineering and technology

• Develop cross-disciplinary professionals who can meet community's needs

Educational Cooperation University of Occupational

and Environmental Health, Japan

Kyushu Institute of Technology

The University of Kitakyushu

Kita-Kyushu City

Kita-Kyushu Chamber of Commerce

and Industry Fukuoka Prefecture

Kyushu Dental University

Stakeholders

Representative

New approach for periodontal diagnosis

Periodontal examination

Periodontal pocket depth Periodontal probe Probing pressure: 20-30 g

Periodontal probe

X-ray examination

Examination of destructive periodontal tissues

Periodontal examination

New periodptanal examination

Detection of periodontopathic bacterium in periodontal pocket Detection of inflammatory cytokines and mediators in periodontal pocket Detection of periodontal tissue destructive enzyme in periodontal pocket

Neutrophils

Macrophages

Bacterial invasion Destructive enzyme

Endotoxin (LPS)

Activation of macrophages and lymphocytes

Overexpression of inflammatory cytokines such as IL-1 and TNF-alpha

Osteoclast activation

Destruction of connective tissue

Pathogenesis of human periodontaitis

Dental plaque

Dental calculus

Gingival Crevicular Fluid：ＧＣＦ

Detection of periodontopathic bacterium in periodontal pocket Detection of inflammatory cytokines and mediators in periodontal pocket Detection of periodontal tissue destructive enzyme in periodontal pocket

New periodontal examination Electro-chemical chip method

sample Electrode

Electrical response

Detection method

Detection method

Sample on the electrode

Detect

Detection time: a few minutes

Future perspective

Blood sampling

Development of microchip to collect blood serum

Use of this detection system to examine the level of cytokines in blood serum

Detection method

Detection method

Sample on the electrode

Detect

Detection time: a few minutes

Detection of periodontopathic microoraganisms such as Aggregatebacter actinomycetemcomitans (Aa), Poephyromonas gingivalis (Pg), Treponema denticola (Td)

Aa Pg

Td

Interleukin-6 (IL-6)

Detection of cytokines and inflammatory mediators derive from host immune cells Tumor

necrotizing factor-α (TNF-α)

Interleukin-1 (IL-1)

Prostaglandin E2 (PGE2)

10

5

Detection of destructive enzymes derived from periodontopathic bacteria

Protease

Leukotixin (LT)

Cytolethal desting toxin (CDT)

New periodontal diagnosis by Bio-microsensing method

Next Stage 〜Establishment of successful aging in Japan

Medical Information for occupational and environmental health

New diagnosis for periodontal diseases Big data

Integration and analysis

Establishment of new preventive medicine

Periodontal medicine ↓

Prevention of heart diseases, diabetes mellitus and so on

New aspects in periodontal diagnostics

The measurement of periodontal depth would be useful for dentists or dental hygienists during the usual diagnosis, treatment and maintenance of periodontal diseases. However, at the present time, dentists and dental hygienists have to work together with medical staff in view of “Periodontal Medicine” such as systemic diseases mediated by periodontopathic bacteria.

Traditional method The important point to note that an innovative periodontal diagnostics share a lot of biological information in comprehensive medicine. This diagnostic methods would make a great contribution to the decrease of oral infectious diseases as well as their related general disorders and systemic malfunction of elderly citizen by the medical, dental and engineering collaboration.

Innovative method

Thank you for your kind attention