Periodontitis or periodontal disease is an infectious disease of the tissues that provide support to the teeth. Though formal diagnosis of periodontal disease requires a dental examination, signs include gingivitis, bleeding gums, tooth decay, tooth loss, tooth mobility, and receding gums.1 Studies have found that as many as 75% of people in the U.S. have periodontal disease, with 20-30% of those affected having a severe form of the disease.2-4 As we’ll discuss, regenerative medicine for periodontal disease is an exciting treatment option for those with this condition.
What are periodontal disease risks?
Periodontal disease affects the periodontal ligaments which are responsible for holding teeth in the mouth. This causes these ligaments to weaken, leading to tooth loss. In fact, periodontal disease is the leading cause of tooth loss among adults.5 Periodontal disease also increases the risk of a number of other very serious health conditions. This makes treating periodontal disease especially important as some of these conditions can cause serious harm or even death.
Individuals with periodontal disease have a layer of bacteria constantly damaging the tissues around their teeth.6 Though the body attempts to heal this damage, this constant cycle of damage and healing produces chronic inflammation. This chronic inflammation can have severe effects on other body systems as well.
Type 2 diabetes risks
For example, one study found that Type 2 diabetic individuals with periodontal disease are six times as likely to experience worsening of their glycemic control compared to Type 2 diabetics without periodontal disease.7
Other studies have found that treating periodontal disease in diabetics tends to improve glucose condition as well.8-10
Periodontal disease can also be particularly harmful during pregnancy. It’s believed that the infecting bacteria and inflammatory byproducts of periodontal disease are able to breach the placenta, causing harm to the fetus.11
Studies of pregnant women have found that periodontal disease increases the risk of a number of adverse pregnancy outcomes, including:
- Preterm birth
- Low birthweight
Heart disease risks
Finally, researchers have also found that having periodontal disease is associated with 24 to 34% greater risk of coronary heart disease, the leading cause of death in the U.S.1 The elevated risk appears to be compounded among diabetic individuals.
A study following diabetic patients for between one and 11 years found that 82% of those with severe periodontal disease had a major cardiovascular or peripheral vascular event during the study, compared with 21% of patients without periodontal disease.13
How can I treat periodontal disease?
There are several forms of treatment for periodontal disease. Maintaining good oral hygiene (e.g., through brushing and flossing) reduces the risk of periodontal disease.14
When periodontal disease is detected, it is often treated by removing dental plaque and calculus from the affected root and tooth enamel using ultrasonic and hand instruments – a process known as scaling and root planing.15
Though these methods are beneficial in preventing the development or worsening of periodontal disease, scientists have begun to study regenerative treatments for periodontal disease that have the potential to not only halt disease progress, but also reverse the damage it has caused.
What about regenerative medicine for periodontal disease?
Regenerative medicine for periodontal disease represents an exciting new method of treatment for this condition.
The body contains a number of growth factors and stem cells that are involved in the regeneration of damaged tissues. Growth factors trigger the healing process, causing the body to direct stem cells to the area, and supply proteins necessary for cell growth. Stem cells are a type of cell found in certain tissues of the body that have the potential to become multiple types of tissues, depending on the surrounding tissues.
For example, periodontal ligament stem cells can become cells that make up bone, tooth enamel, gums, or ligaments – all tissues of the teeth and their support structures.5 Stem cell therapies work by extracting stem cells, either from the patient themself or from another donor.
These stem cells can then be delivered to an area in need of treatment. The stem cells then differentiate into the appropriate tissue, leading to growth and healing of damaged tissues.
Stem cell therapy for periodontal disease
Regenerative treatments, such as stem cell injections, have demonstrated the ability to heal damaged tissues in a number of areas of the body, including degenerated intervertebral discs and cartiliage lost in the knees due to arthritis.16,17 Studies also support the potential for stem cell treatment to treat periodontal disease as well.
For example, one study tested stem cells in treating a miniature pig model of periodontal disease.5 In this study, periodontal ligament stem cells were taken from pigs and injected into an area around the diseased teeth. Within 12 weeks, the periodontal tissues were stronger and showed better attachment to the teeth, compared with untreated controls. Stem cell treatment has shown similar benefits in studies of humans as well.
PRP therapy for periodontal disease
Another type of widely-used regenerative treatment is platelet rich plasma therapy or PRP therapy. PRP therapy involves drawing a small amount of the patient’s blood and spinning the blood in a centrifuge.18 This causes the different components of the blood to separate in a top layer of plasma only, a bottom layer of red blood cells, and a middle layer containing platelets.
This middle layer, known as platelet rich plasma, is separated out and injected at one or more treatment sites. Platelets are best known for their role in clotting blood, but they also contain the growth factors necessary for long-term healing. Additionally, stem cells are present in the PRP component of the blood. The growth factors present in PRP stimulate the healing process at the site of damaged tissues, drawing stem cells in and supplying the necessary components for regrowing tissues.
PRP therapy is commonly used by professional athletes to speed the process of recovering from an injury. Additionally, PRP therapy has shown the ability to treat periodontal disease in clinical trials.
The research on PRP therapy
For example, one study of 70 patients with moderate to severe periodontal disease found that injections of PRP and bone graft led to decreased bone defects and greater tooth attachment after 12 months, compared with untreated teeth.19 Another study of 18 young patients undergoing third molar (i.e., wisdom tooth) extractions found that the injection of PRP during the procedure resulted in fewer bony defects and better attachment of the second molars.20
Further, a case report of a person with severe periodontal disease who was treated with a combination of PRP and their own stem cells found that periodontal tissues became stronger.21 Bleeding of the periodontal tissue and mobility of the tooth stopped.
Do you have additional questions about regenerative medicine for periodontal disease? Give our office a call today!
- Humphrey LL, Fu R, Buckley DI, Freeman M, Helfand M. Periodontal disease and coronary heart disease incidence: A systematic review and meta-analysis. J Gen Intern Med 2008;23:2079-86.
- Brown LJ, Brunelle JA, Kingman A. Periodontal status in the United States. J Dent Res 1996;75:672–83.
- Douglass CW, Jette AM, Fox CH, et al. Oral health status of the elderly in New England. J Gerontol 1993;48:M39–46.
- Papapanou PN. Periodontal diseases: epidemiology. Ann Periodontol 1996;1:1–36.
- Liu Y, Zheng Y, Ding G, et al. Periodontal ligament stem cell-mediated treatment for periodontitis in miniature swine. Stem Cells 2008;26:1065-1073.
- Stanko P, Holla LI. Bidirectional association between diabetes mellitus and inflammatory periodontal disease: A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014;158:35-38.
- Taylor GW, Burt BA, Becker MP, Genco RJ, Shlossman M, Knowler WC, Pettitt DJ. Severe periodontitis and risk for poor glycemic control in patients with non-insulin-dependent diabetes mellitus. J Periodontol 1996;67:1085-93.
- Darre L, Vergnes JN, Gourdy P, Sixou M. Efficacy of periodontal treatment on glycaemic control in diabetic patients: a meta-analysis of interventional studies. Diabetes Metab 2008;34:497-506.
- Teeuw WJ, Gerdes VE, Loos BG. Effect of periodontal treatment on glycemic control of diabetic patients: a systematic review and meta-analysis. Diabetes Care 2010;33:421-7.
- Simpson TC, Needleman I, Wild SH, Moles DR, Mills EJ. Treatment of periodontal disease for glycaemic control in people with diabetes. Cochrane Database Syst Rev 2010;5:CD00471
- Madianos PN, Boetsis YA, Offenbacher S. Adverse pregnancy outcomes (APOs) and periodontal disease: Pathogenic mechanisms. J Clin Periodontol 2013;40(Suppl. 14):S170-S180.
- Xiong X, Buekens P, Fraser WD, Beck J, Offenbacher S. Periodontal disease and adverse pregnancy outcomes: A systematic review. BJOG 2006;113:135-153.
- Thorstensson H, Kuylensteirna J, Hugoson A. Medical status and complications in relation to periodontal disease experience in insulin-dependent diabetics. J Clin Periodontol 1996;23:194-202.
- Suomi JD, Greene JC, Vermillion JR, Chang JJ, Leatherwood EC. The effect of controlled oral hygiene procedures on the progression of periodontal disease in adults: Results after two years. J Periodontol 1969;40:416-420.
- Michalowicz BS, Hodges JS, DiAngelis AJ, et al. Treatment of periodontal disease and the risk of preterm birth. N Engl J Med 2006;355:1885-1894.
- Crevensten G, Walsh A, Ananthakrishnan D, Page P, Wahba GM, Lotz JC, Berven S. Intervertebral disc cell therapy for regeneration: Mesenchymal stem cell implantation in rate intervertebral discs. Ann Biomed Eng 2004;32:430-434.
- Wakitani S, Imoto K, Yamamoto T, Saito M, Murata N, Yoneda M. Human autologous culture expanded bone marrow mesenchymal stem cell transplantation for repair of cartilage defects in osteoarthritic knees. Osteoarthritis Cartilage 2003;10:199-206.
- Tozum TF, Demiralp B. Platelet-rich plasma: A promising innovation in dentistry. J Can Dent Assoc 2003;69:664-664h.
- Okuda K, Tai H, Tanabe K, et al. Platelet-rich plasma combined with a porous hydroxyapatite graft for the treatment of intrabony periodontal defects in humans: A comparative controlled clinical study. J Periodontol 2005;76:890-898.
- Sammartino G, Tia M, Marenzi G, di Lauro AE, D’Agostino E, Claudio PP. Use of autologous platelet-rich plasma (PRP) in periodontal defect treatment after extraction of impacted mandibular third molars. J Oral Maxillofac Surg 2005;63:766-770.
- Yamada Y, Ueda M, Hibi H, Baba S. A novel approach to periodontal tissue regeneration with mesenchymal stem cells and platelet-rich plasma using tissue engineering technology: A clinical case report. Int J Periodontics Restorative Dent 2006;26:362-369.