Research Profile - Rinse, spit and stay healthy
Dr. Michael Glogauer
A painless procedure that can be done in a dentist's office may predict a chronic condition linked to cardiovascular problems and cancer risk
It is the most common medical condition in the world, yet most people are blithely unaware of its presence and the damage it can do.
"Probably 90% to 95% of people experience some form of periodontal disease (PD) in their lifetime," says Dr. Michael Glogauer of the University of Toronto's Faculty of Dentistry. "That ranges from gingivitis all the way to severe periodontitis."
At a Glance
Who – Dr. Michael Glogauer, Associate Professor, University of Toronto, Faculty of Dentistry.
Issue – Periodontal disease (PD), an inflammation of the tissues that surround and support the teeth, is a common condition that often goes undetected. Beyond damaging teeth, PD sends chemicals into the bloodstream that can lead to new infections or worsen existing conditions such as diabetes, cardiovascular problems or Rheumatoid Arthritis.
Approach – Dr. Glogauer has developed dental office water-rinse test that detects elevated oral inflammatory cell counts that indicate the presence of PD.
Impact – Dentists and patients will be able to detect and treat PD earlier, preventing long-term damage. Dr. Glogauer is partnering with a Canadian company to bring the test to market.
Periodontal disease (PD), an inflammation of the tissues that surround and support the teeth, often goes undetected while it quietly destroys the bone and ligaments that support the teeth. Beyond causing dental difficulties, it also sends chemicals into the bloodstream that can lead to new infections or worsen existing conditions such as diabetes and Rheumatoid Arthritis. A growing number of studies suggest that PD, sometimes referred to as gum disease, puts people at higher risk for stroke, heart attack and atherosclerosis, and the dental condition has even been linked to an increased risk of certain cancers.
"Every single day I see a paper linking PD to other systemic health problems," says Dr. Glogauer. "But the condition itself is, for the most part, painless and slowly progressive, so people tend not to take it seriously."
Until now, the way to tell if you have PD has been for your dentist to look for damage or inflammation in the oral tissues.
"The problem is we're looking for disease after it's already caused significant damage," says Dr. Glogauer. "I wanted to come up with a test that would provide an early warning system – as opposed to waiting for significant damage to show up."
He has developed a simple test that can be done in the dentist's office to detect elevated inflammatory cell counts in the mouth – an indicator that PD is present well before any clinical symptoms become evident.
"Essentially, it's a colour reaction – like a pregnancy test. The patient rinses their mouth with water for 30 seconds and spits into a cup where a special reagent is added. A cap is put on the cup; it's shaken and if it turns blue you have – or are on the way to having – gum disease."
It's the colour change that has the impact on the patient, says Dr. Glogauer.
"You go to your dentist and they poke around and say, 'You might have a problem here with PD.' The patient will say, 'I'm not feeling any problems.' But if you can actually show the patient the colour change, the visual effect is very powerful. That can go a long way to helping patients appreciate the problem."
Early detection of PD can trigger early treatment – more frequent cleaning appointments, localized antibiotic treatments or antibacterial rinses – before teeth are lost or potentially infectious chemicals flow into the bloodstream.
Dr. Glogauer has patented the test in the United States (with a patent pending in Canada) and is working with a Canadian company, CHX Technologies, to take it to market. The next step is a clinical trial this summer, partly funded by the Canadian Institutes of Health Research, to demonstrate the test's ability to predict the onset of PD.
Mr. Ross Perry, owner of CHX Technologies, sees baby boomers as the largest potential market for the PD rinse test.
"We're excited about commercializing the test because we know that older patients are really keen about preventive medicine and maintaining their teeth intact for as long as they can."
The Study
Over several years, Dr. Glogauer has tested various formulations of his PD test with participants at the U of T's Faculty of Dentistry. He is currently fine-tuning the formulation for a prospective clinical trial of 450 patients commencing this summer.
"If we get the predictive values we hope for and expect from this next study, it will be the final clinical trial before commercialization" said Dr. Glogauer.
Patients will be recruited and given the rinse test. Researchers will then monitor them over several months to see if the test accurately predicted those who develop PD problems.
"CHX is interested from the standpoint of predicting who is going to get PD. They want to follow patients who, at the entry, are healthy orally but develop a problem," says Dr. Glogauer. "They want to show that the colour change predicts who runs into trouble."
"For me as a scientist, it would be great to see something translated all the way from the lab bench to being used by patients. I've been working on this for about seven years. What I have learned is that it's unbelievably complicated to take an idea from the bench and get it into a product.
Dr. Michael Glogauer