new aspects in periodontal diagnostics - gohc2019.t 5-2 dr. nishihara.pdf1. pathogenesis o f...
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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
Tatsuji Nishihara, D.D.S., Ph.D. Present Status: Chairman and President Emeritus Professor Kyushu Dental University E-mail: [email protected]
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
Periodontopathic bacteria
Porphyromonas gingivalis Treponema denticola Tannerella forsythia Aggregatibacter actinomycetemcomitans Prevotella intermedia
Peridontopathic bacterium of
juvenile periodontitis
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”
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
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 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
Periodontal examination
Periodontal pocket depth Periodontal probe Probing pressure: 20-30 g
Periodontal probe
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