A new way of classifying gum disease may speed detection of serious periodontitis before patients lose teeth and bone.

Today, periodontal disease is classified as either chronic or aggressive, based on the severity of clinical symptoms and signs including gum swelling and the loss of facial bone structure. But those designations do little for diagnosis and treatment, given significant overlap between the two.

"Many patients with severe symptoms can be effectively treated, while others with seemingly less severe infection may continue to lose support around their teeth even after therapy, study leader Panos P. Papapanou, a dental professor at Columbia University Medical Center, said in a statement. “Basically, we don't know whether a periodontal infection is truly aggressive until severe, irreversible damage has occurred."

Earlier Detection For Gum Disease Promised
By looking at the expression of thousands of genes in gum tissue, researchers can now classify most cases of periodontitis into one of two clusters. More severe cases of the disease are represented under the red bar, less severe cases under the blue bar. The findings may allow for earlier diagnosis and more personalized treatment of severe gum disease, before irreversible bone loss has occurred. Panos N. Papapanou, D.D.S., Ph.D./Columbia University College of Dental Medicine

To improve the disease classification system, Papapanou followed the lead of oncologists who’ve found that indications of a cancer’s aggressiveness — as well as its response to treatment — may be found in its genetic material. In the lab, the Columbia researchers performed genome-wide expression analyses of diseased gum tissue samples taken from 120 age-diverse patients with either “type” of periodontitis.

Based on the genetic analysis, the researchers found that periodontitis may indeed be classified into two groups. However, “the [groups] did not align with the currently accepted periodontitis classification," Papapanou said.

Moreover, the researchers also found higher levels of infection by two known oral pathogens, as well as greater severity of disease, among one group. That higher-risk group also included more men than women, which researchers said validated previous observations about the disease.

"Our data suggest that molecular profiling of gingival tissues can indeed form the basis for the development of an alternative, pathobiology-based classification of periodontitis that correlates well with the clinical presentation of the disease," Papapanou said.

Although performing genomic testing on patients would be impractical, the Columbia team hopes to discover biomarkers for the two different types of periodontitis, potentially improving treatment. "If a patient is found to be highly susceptible to severe periodontitis, we would be justified in using aggressive therapies, even though that person may have subclinical disease," said Papapanou said. "Now, we wait years to make this determination, and by then, significant damage to the tooth-supporting structures may have occurred.

The Mayo Clinic says periodontitis is "common but preventable" — the result of improper dental hygiene.

Source: Papapanou, Panos N., Kebschull, M., Demmer, R.T., Grun, B., Guarnieri, P., Pavlidis, P. Gingival Tissue Transcriptomes Identify Distinct Periodontitis Phenotypes. Journal of Dental Research. 2014.