The 'oral-systemic link' marches forward: Salivary diagnostics support medical/dental collaborations

By Lisa C. Wadsworth, RDH, BS

At least 10 years ago, it was exciting and daunting to begin the oral-systemic discussion with dentists, hygienists, and assistants who were eager to raise the "gold standard" of care for their patients. Ten years later, the medical community is joining us in the fight against gingivitis and periodontal disease by blending the message of oral health equals/influences overall health.

Research followed by successful patient management is only strengthened by the acceptance and influence of the other. Groups such as Scientific American and the New York Academy of Sciences are bringing together clinical team members from the medical and dental arena to share research and success stories.

Patient care in a medical setting draws information and diagnosis from the results of screenings from blood, skin, and urine to name a few. Bacteria testing for strep throat and urinary tract infections are commonplace. The dental community has begun to accept bacteria testing via several methods to shape or alter treatment recommendations.

Several years ago, I had the pleasure to write about salivary diagnostics available to the dental community (RDH magazine 2014). The article focused on the science and technical process of salivary DNA testing and two different types of testing available via this process. The focus then was on the company we have come to know as OralDNA Labs.

OralDNA Labs uses a saliva swish and expectorate collection system to provide the samples needed for testing. The two tests are MyPerioPath, which identifies the type and quantity of the 13 primary bacteria implicated in causing periodontal disease, and MyPerioID PST. This latter test also uses a saliva sample collected at chairside. The purpose of this test to is determine if the patient is genetically predisposed to periodontal disease by looking for the presence of a specific genotype in the patient's DNA called interleukin-1 (IL-1). The OralDNA system offers suggestions for systemic antibiotics that will help control or destroy harmful bacteria in the oral cavity.

Continuing the Charge

With clinical testing and growth in Canada over the last 10 years, another salivary diagnostic company is making its way to U.S. practices. The company is OraVital Inc. The services consist of a proprietary protocol of advanced microbiology tests-BiofilmDNA and BiofilmGS (Gram stain)-combined with a personalized regimen of prescribed antibiotic/antifungal and antimicrobial rinses or cream for the oral cavity. The rinses and creams are not systemic antibiotics; therefore, the patient does not face the side effects often associated with oral antibiotics.

OraVital's BiofilmDNA is a sensitive DNA test that detects both the presence and thresholds of specific pathogens via collected salivary, subgingival, and tongue biofilm samples. This advanced biofilm analysis provides the dental clinician with a detailed, multi-panel, whole-mouth picture of the patient's oral condition.

Furthermore, with the use of the BiofilmDNA test the practitioner can specifically target one area of high concern such as perimucositis or peri-implantitis. Depending on test results, an antibiotic/antifungal or antimicrobial rinse or cream can be prescribed by the attending dentist.

A Cultural Change

Why salivary diagnostics? We are now able to gather detailed information about the exact bacteria that are attacking our patients' mouths and overall health. With science and laboratory reports in hand, we can educate our patients to take ownership of a problem that too frequently patients did not believe they had, leaving us with no clear way to present our case. As we know, periodontal disease and/or peri-implantitis are often the silent, asymptomatic disease processes that do not elicit action from the patient until well into the late stages of disease.

Our goals as practitioners has changed from "watching" gingivitis or trying to justify why we treatment plan for scaling and root planing. With salivary diagnostics, the hygienist and patient can work in harmony towards the common goal of overall health.

In retrospect, 10 years ago was a different time. Spreading the message of the "oral-systemic link" and new treatments such as salivary diagnostics might have been a bit too much to explain. Maybe the technology, coupled with a new way to diagnose with certainty, was too much too fast. We were engaged (some may say scared of the new reality), busy honing our communication skills, conquering the hurdles and pushback each day. But, in fast forwarding to today, blending the two will make our treatment plans so much more powerful and have led to more stable and consistent results for the patients we serve.

With several simple collection systems for salivary diagnostics and treatment options for all levels of medical compromises, we can educate and focus patients swiftly towards consistent results and overall health. The medical and dental communities are coming together; many corporate entities are engaging in continuing education platforms including members from both clinical backgrounds. Science and excitement for advanced and often less complicated patient care are driving the collaboration between physicians, dentists, nurses, and hygienists. We are all on the forefront of the paradigm shift to oral-systemic patient care.

Salivary diagnostics could and did revolutionize the diagnosis and treatment of periodontal disease and the diseases influencing implant therapy. All patients have potentially illness-causing bacteria in their mouths. No one is immune to oral infections; salivary diagnostics bring physicians and dentists together to support each other's management of patient care. When the levels of both good and bad bacteria are in balance (homeostasis), disease is kept at bay. However, when the quantity of pathogenic bacteria rise above a specific number, called the disease threshold, infection and illness is likely to occur or is already present.

Knowing the quantity of each type of pathogenic bacteria is important because merely having a presence of any of these bacteria in the mouth does not necessarily mean there is an infection or periodontal disease. Hence, the discussion of the "host" or specific personal response to a bacterial invasion.

Home Care Support for the Patient

With clinical support of scaling and root planing, oral antibiotics, or antibiotic rinses or creams, we are poised to win the fight against gingivitis, periodontitis, or peri-implantitis. One more helpful, research-supported home-care aid is electric or sonic toothbrushes. The biofilm present in the mouth is tough, thick, hard to disrupt, yet must be successfully disturbed every eight hours. To ensure our patients can win this battle at home, electric or sonic toothbrushes are recommended over manual brushes.

Electric and sonic brushes have been proven safe for use around natural teeth and implant-supported restorations. Electric brushes such as Rotadent or Oral-B can be recommended. Sonic brushes-is there a preference? Yes, the Sonicare brush by Philips. Why? The sonic technology has a vast library of research supporting the efficacy and safety for use around dental implant restorations. Another reason for choosing sonic technology? The Sonicare has been given the title of a "medicament delivery device," because of the sonic ability to deliver prescribed gels, pastes, or rinses 3 mm past the end of the bristle tip. With this knowledge, we know the medicaments chosen will be driven deep interproximally. This area has historically been a challenge for at-home patient care. It is very important to disrupt the bacterial load.

Gather your favorite at-home cleaning devices, arm yourself with clear expectation about your product choices, and, in doing so, reward your patients with a successful path to successful home care unique to everyone.

Patient and Oral Systemic Message

With the results of salivary testing guiding our treatment recommendations, the success of subsequent treatment is reliant on the patient and hygienist working together to gain control of oral disease. In concert with our dentist and physician colleagues, we are given the responsibility to ensure that either oral antibiotics are taken as prescribed, or that prescription rinses and creams are used correctly.

The oral-systemic message is growing louder and researchers' results continue to be publicized in consumer media. The importance of oral health is strongly associated with the ability to maintain overall health and influence how a physician can deter or correct a disease process. Together the medical and dental community are creating overall health. Are you ready to be part of the movement and this scientific solution for patient care? RDH

Lisa Wadsworth, RDH, BS. owns Lisa C. Wadsworth, Inc, a company focused on serving the dental community. She lectures nationally, contributes to many major dental publications and provides in-office coaching for personal and professional development. Lisa is a Key Opinion Leader for Philips Sonicare and is currently retained to supervise the launch of USA hygiene educators for OraVital Inc. She can be reached at (215) 262-6168 or via her Web site or email of [email protected].