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10 questions on genetic testing, periodontal disease, and the role of the dental professional

Issue 11

I recently had the chance to sit down with two executives from Interleukin Genetics - Dr. Kenneth Korman, the company’s chief executive officer, president, and chief scientific officer (below left), and Scott Snyder, the company’s chief marketing officer (below right) - to discuss the company and its vision for the dental industry.

I recently had the chance to sit down with two executives from Interleukin Genetics - Dr. Kenneth Korman, the company’s chief executive officer, president, and chief scientific officer (below left), and Scott Snyder, the company’s chief marketing officer (below right) - to discuss the company and its vision for the dental industry.

According to the company’s Web site, “Interleukin Genetics, Inc. is a genetics-based personalized health company that develops genetic tests for use in the emerging personalized health market. We believe that the science of applied genetics can empower physicians and dentists to improve management of chronic diseases, and empower individuals to personalizetheir own health.”

The company recently introduced PerioPredict, described as a simple genetic test shown to predict a patient’s increased risk for developing severe periodontal disease. We wanted to learn more about the product, the company’s vision, and how they believe genetic testing will impact dentists, dental hygienists, and dental practices in the near future.

Why was PerioPredict® created and why is it important to dentistry?

We have known for many years that not everyone responds the same way to bacterial plaque, and a small number of risk factors appear to explain much of those differences. For example, about 50% of the variation in clinical severity of chronic periodontitis among patients appears to be due to genetic differences, and smoking and uncontrolled diabetes are well-established as factors that modify our approach to prevention and treatment of periodontitis.

In spite of almost 50 years of evidence about how to prevent and treat periodontitis, we still have many individuals with disease and many with the complications of severe disease, such as tooth loss. We now know that patients with a small set of risk factors, including smoking, uncontrolled diabetes, IL-1 genetic variations, and a few others, are enriched with moderate to severe generalized periodontitis.

A study out of the University of Michigan, using more than 80,000 patient-years of insurance claims data, asked the question whether one could use current knowledge about the major risk factors to better prevent severe periodontitis. This study on more than 5,000 regular dental patients who had no prior diagnosis of periodontitis were monitored for 16 years. The data confirmed that smoking, diabetes, and the IL-1 genetic test could be used to stratify patients for improved prevention of tooth loss. The bottom line is that some patients really needed two cleanings annually, some appeared to need more than two, and for some one or two cleanings annually did not show a difference.

We now have evidence that supports the clinical need to know our genetics, and provides new support for using the PerioPredict® Interleukin-1 (IL-1) genetic risk test.

So now dentistry can move from “what if” to “now we can” because we now know that it makes clinical sense to do so. With access to this test, dental professionals can tap the power of genetics in their practice.

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If genetics is playing such a big role in periodontal disease, how can dental professionals help their patients?

Dental professionals have always adapted their treatment plans based on their knowledge of the individual patient. Now we have more information on personal risk factors. We know that diabetes, smoking and genetics can really drive patient health outcomes. We now know that nearly one in three individuals who are seen regularly in dental offices for preventive care have the IL-1 gene variation. How many of them are aware of that? This represents a real opportunity for the dental professional to use additional information in their planning of how to best prevent severe periodontitis and its consequences in individual patients. Most importantly, the disease effects of the IL-1 gene variations can be controlled by oral hygiene and professional preventive care, similar to how we routinely control the increased periodontitis risk from smoking and uncontrolled diabetes.

Why is periodontal disease still such a problem in our nation?

As we all know, periodontitis typically doesn’t produce symptoms that are evident to the patient until late stages of the disease.

We know that almost half of the American adult population suffers from periodontal disease, yet only a small percentage have been diagnosed and treated.

The major complications of periodontitis, such as mobility, tooth loss, and increased risk for various medical conditions are related to generalized moderate to severe periodontitis, which is concentrated in populations without access to care, patients who have access but choose to see the dentist only for urgent care, and patients who see the dentists regularly for preventive care but also have certain risk factors that require more diligence in patient home care and more professional preventive care. If we start by focusing on the patients we see regularly, there is a major public health opportunity and a key opportunity for dentistry.

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How does this product assist the dental professional when talking to patients?

Patients today are very much aware of personal differences that can affect their health. Knowing one’s genetic status for a particular condition – positive or negative – is concrete and compelling. And it doesn’t change; it will be a factor for your entire life. This can be a very persuasive counseling tool. Patients become more engaged. What we’re hearing from professionals is that it has the power to strengthen the clinician-patient relationship. Now you really have the patient’s attention. They may be more accepting of your recommendations and treatment plans. Some patients say they view their dental professional more positively for having provided leading edge technology. Of course plaque is the cause of periodontitis, so being negative for a genetic predisposition to periodontitis or any other single risk factor does not mean the patient has no risk but rather is at normal risk that still requires close attention to professional and personal plaque control.

This seems to further push the relationship between the dental and medical communities. How do you feel dental professionals should be working with their medical counterparts?

Dental professionals can take the lead in opening up lines of communication with physicians when patients present with conditions of interest to both. For example: When a patient who has diabetes is diagnosed with periodontal disease it is valuable for the dentist or dental hygienist to inform the physician’s office, include the patient’s periodontal chart, and request lab results be faxed back to their office along with input from the physician. When a patient is identified by the dental practice as having IL-1 genetic risk for severe periodontitis, we know that patient over produces inflammation. That information can be shared with the patient’s physician to inform of the potential risk of complications for systemic conditions and to be aware of potentially severe gum disease.

Additional reading: CDC report on periodontal disease and minorities

What has been the feedback from dental professionals and patients?

The value of genetic testing is increasingly being recognized and, because of that, we’ve worked hard to support the test with strong science and with strong customer support.

As we mentioned, individuals who know their genetic risk status are reported to be more motivated and engaged. It can also help keep the periodontal maintenance patient motivated to stick with the care plan. In the case where insurance coverage for the PerioPredict® test has been implemented, along with coverage of additional preventive recall visits for high risk patients, professionals and patients have seen this as a big plus. The exact implementation of this new risk-based approach to preventive care is still in its infancy, and employers and insurers will likely implement insurance plans in multiple ways. But there’s clearly a growing recognition of the clinical value of knowing who has this “invisible risk factor.”

Is this geared more toward the dentist or hygienist?

Both are vital. Anytime new technologies or services are introduced to patients, you want the dentist and dental hygienist on the same page in terms of how patients are informed of potential benefits. While dental hygienists may play a greater role in answering patients questions related to salivary testing everyone, including the office staff can play a role in helping to educate patients and support the change that’s required.

The idea of genetic testing in the dental office is still a very new concept. How are you explaining it to people?

You’re absolutely right. Although awareness of genetic testing is growing rapidly, people still aren’t expecting to be offered a genetic test by their dentist! We’ve been successful in using the example of cholesterol testing. The periodontal genetic risk test really works in the same way and it’s an example that most people are familiar with. You visit the doctor’s office and they offer a routine test that helps identify disease risk. It’s sent to a lab for analysis, the doctor receives the results and communicates the results to the patient along with interpretation, counseling and treatment planning based on the unique risk profile of that individual. This is then used to guide future preventive care, and to help engage the patient in the process of maintaining their health. Since the clinical effect of this genetic factor can be modified by good home care and professional preventive care, it easily fits into the context of other risk factors for periodontitis, like smoking and uncontrolled diabetes. When described in that familiar context, it really demystifies the entire process.

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How can dental professionals convey this message to their patients who might be overdue for an appointment?

A simple way to get a patient’s interest is to include a tag line with their email or postcard reminders that they are past due such as, “Are genetics influencing disease in your mouth? Learn more at your next dental visit!”

What do you see for the future of genetic testing and dentistry?

There are actually multiple genetic testing applications moving into dentistry. These will continue to grow as we identify genetic markers that can identify disease or disease risk. Increasingly, patients are aware of the role of genetics in their personal health, which will drive demand for genetic testing. However, in order to achieve wide adoption and tap their potential value, genetic tests will need to meet two essential criteria, just as in medicine. First, they must demonstrate strong clinical utility, which means there must be a well-established clinical benefit based on solid evidence-based research. Second, broad adoption of genetic testing will require demonstrating cost effectiveness. This will enable employers and third party payers to get behind these innovations and provide true access. Once this is established, we can expect to see genetic testing truly achieve its potential and become a core element of how we manage patient health in dentistry. 

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