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Minimally Invasive Diagnostic Tools in the Diagnosis of Periodontal Disease

August 16th, 2019

January 11, 2018
by Zahra Dorna Mojdami, HBSc, DDS; Michael Glogauer, DDS, Dip Perio, PhD; Amir Azarpazhooh, DDS, MSc, PhD, FRCD(C)


The most common chronic inflammatory conditions worldwide and collectively the most common diseases known to mankind, are inflammatory periodontal diseases.1 Periodontal diseases include gingivitis, where the inflammation confined to the gingiva is reversible with good oral hygiene, and periodontitis, an extension of the inflammation that results in tissue destruction and alveolar bone resorption.1 Periodontitis is very common with 10-15% of adults being afflicted with severe periodontitis and 40-60% being affected by moderate periodontitis.2 Several forms of periodontitis have been recognized; however, the predominant category is chronic periodontitis (CP) which remains the number one cause of tooth loss in adults worldwide.3 The goal of periodontal diagnostic tools and procedures is to provide useful information to the clinician on the periodontal disease type, location, and severity. This information will serve as the basis for treatment planning and monitoring of disease.4 Traditional periodontal clinical diagnostic parameters include probing depths, bleeding on probing, clinical attachment levels, plaque index, and radiographs.5 The strengths associated with these traditional tools are that they are easy to use, cost-effective, and are relatively non-invasive.5 However, these traditional diagnostic procedures are limited in that only disease history, not current disease status and activity, can be assessed and identified.5,6 For example, clinical attachment loss readings by the periodontal probe and radiographic evaluation of alveolar bone loss measure damage from past episodes of destruction and require a 2 to 3 mm threshold change before a site can be identified as having experienced a significant anatomic event.5 Even in instances when patients’ treatments are monitored over time it can be difficult to use these clinical parameters to make a definitive periodontal diagnosis.5 As another example, does a patient who has been treated with non-surgical periodontal treatment and now has several sites with residual probing depths that bleed on probing still have periodontitis that requires further active therapy or surgical treatment, or is the condition stable and the disease in remission?7 Moreover, other limitations such as the difficulty in precisely duplicating the insertion force, probe placement and angulation exist.8 Radiographs, a key factor in determining the severity of periodontitis and bone-related damage, have limited sensitivity and only reveal change in bone after 30% to 50% of bone loss has occurred.8 Furthermore, radiographs cannot be taken at each visit due to excess radiation exposure to the patient.8 Advances in oral and periodontal disease diagnostic research are consequently moving forward toward methods whereby periodontal diagnosis and risk can be identified and quantified by measures that are objective7, minimally invasive, less technique sensitive, less time consuming and that are able to identify active and potential periodontal disease. New developments in periodontal diagnostic research will be discussed below.




August 8th, 2019

U of T Dentistry’s professor Chris McCulloch was honoured with the first-ever Canadian Association of Dental Research (CADR) /Association of Canadian Faculties of Dentistry (ACFD) National Dental Research Award at a special awards ceremony on June 18 held in Vancouver.

The award recognizes McCulloch’s remarkable contributions across the field of oral health, but also his mentorship, his research innovation, and his leadership.

At the ceremony, the awards committee outlined a number of McCulloch’s accomplishments, which include 295 peer-reviewed papers; over 9,500 citations, and a remarkable H-index score of 61. Over the course of his career, the committee noted, McCulloch has received over $55,000,000 in research funding.

“Chris has been one of the most productive researchers in the Canadian basic science landscape – far beyond dental research,” said Bernhard Ganss, vice dean of research, in a statement. “He has continuously held competitive funds through tri‐council agencies and other highly competitive agencies. And he has forged collaborations on a national, international and global scale,” Ganss added.

Lauded for his impact on research, specifically his work on cell-matrix communications, the award also captured McCulloch’s far-reaching impact on academia: he has graduated 25 PhD and 35 MSc students and currently has 10 trainees under his supervision.

The ceremony took place as a prelude to the International Association of Dental Research (IADR) conference, held in Vancouver on June 19-22.


Photo: Courtesy Marna MacDonald


August 8th, 2019

Dentistry’s Professor Michael Glogauer, DDS 9T3, PhD 9T9, has been awarded a prestigious Canadian Academy of Health Sciences (CAHS) Fellowship.

Induction into the CAHS as a Fellow is considered one of the highest honours within Canada’s academic community and focuses on bringing together Canada’s top-ranked health and biomedical scientists and scholars to make a positive impact on the urgent health concerns of Canadians.

“This is a real privilege,” says Dr. Glogauer. “Being a clinician-scientist is the best job in the world. There is creativity and problem solving involved and we get to work towards answering important questions.”

Within CAHS, there is a select group of dental clinicians. Dr. Glogauer joins University of Toronto’s Dr. Christopher McCulloch, as well as Dr. Chris Overall from University of British Columbia and Dr. Paul Allison from McGill University in the Dentistry stream of CAHS.

Dr. Glogauer says this will afford him the opportunity to demonstrate how important funding is to the work of dental clinician scientists – and to the lives of Canadians. “The oral cavity is connected to the rest of the body where health problems can be initially detected by dentists. For example, diabetes often presents with an infection in the mouth,” he says. “With improved communication between the dentist and the rest of the health care team, we can potentially carryout earlier detection of new cases of diabetes, improve patient health, and reduce costs to the healthcare system.”

Dr. Glogauer is a leader in oral innate immunity in health and disease. As a dental clinician scientist, he focuses on understanding how oral disease impacts on general health. The Glogauer lab has revealed novel concepts of distinct neutrophil (an immune cell that is one of the first cell types to travel to the site of an infection to help fight infection) activation states in oral health and periodontal disease and how shifts in neutrophil activation can be used as a diagnostic biomarker for early detection of periodontal diseases and furthermore, how oral disease can impact systemic health. He uses this knowledge to understand the impact of socio-economic status and lack of dental care access on overall health.

Dr. Glogauer is also an internationally-recognized leader in the fields of innate immunity, neutrophil function, and periodontal diseases. His research, which focuses on neutrophils, has resulted in important publications describing regulators of neutrophil function, immune regulation of periodontal disease, and alveolar bone loss. This work has led to two patents, one license, and two license disclosures.

It has also has led to the development of a novel non-invasive oral rinse test for periodontal disease, the leading inflammatory condition in humans. This test is based on 10 years of research in his lab (12 publications; 15 students) and has resulted in the creation of technology licensed to a Canadian company (Oral Sciences Inc.) for a diagnostic rinse test called PerioMonitorTM. It is in the final phase of clinical testing as required by the FDA and Health Canada for approved use in medical and dental offices. This rinse will be the first tool to allow for rapid screening for periodontitis in a non-dental setting.

This test builds on Dr. Glogauer’s goal of overcoming the “dental disease blind spot” in the Canadian health care system that impacts the overall health and quality of life of Canadians. Dr. Glogauer’s focus on connecting oral health to general well-being is also highlighted by his monthly speaking and teaching engagements to stakeholders in the healthcare community.

Dr. Glogauer is also the recent recipient of a grant from the Network for Canadian Oral Health Research (NCOHR): New Frontier Seed Grant Program (2018) for his work entitled: “Monetite biomaterial grafts loaded with a novel bone anabolic conjugate C3 conjugate drug to achieve more predictable and greater bone regeneration.



Role of Fibroblast Populations in Periodontal Wound Healing and Tissue Remodeling

August 1st, 2019


After injury to periodontal tissues, a sequentially phased healing response is initiated that enables wound closure and partial restoration of tissue structure and function. Wound closure in periodontal tissues involves the tightly regulated coordination of resident cells in epithelial and connective tissue compartments. Multiple cell populations in these compartments synergize their metabolic activities to reestablish a mucosal seal that involves the underlying periodontal connective tissues and the attachment of these tissues to the tooth surface. The formation of an impermeable seal around the circumference of the tooth is of particular significance in oral health since colonization of tooth surfaces by pathogenic biofilms promotes inflammation, which can contribute to periodontal tissue degradation and tooth loss. The reformation of periodontal tissue structures in the healing response centrally involves fibroblasts, which synthesize and organize the collagen fibers that link alveolar bone and gingiva to the cementum covering the tooth root. The synthesis and remodeling of nascent collagen matrices are of fundamental importance for the reestablishment of a functional periodontium and are mediated by diverse, multi-functional fibroblast populations that reside within the connective tissues of gingiva and periodontal ligament. Notably, after gingival wounding, a fibroblast sub-type (myofibroblast) arises, which is centrally involved in collagen synthesis and fibrillar remodeling. While myofibroblasts are not usually seen in healthy, mature connective tissues, their formation is enhanced by wound-healing cytokines. The formation of myofibroblasts is also modulated by the stiffness of the extracellular matrix, which is mechanosensed by resident precursor cells in the gingival connective tissue microenvironment. Here, we consider the cellular origins and the factors that control the differentiation and matrix remodeling functions of periodontal fibroblasts. An improved understanding of the regulation and function of periodontal fibroblasts will be critical for the development of new therapies to optimize the restoration of periodontal structure and function after wounding.

Author information

Smith PC1, Martínez C1, Martínez J2, McCulloch CA3.

Front Physiol. 2019 Apr 24;10:270. doi: 10.3389/fphys.2019.00270. eCollection 2019.

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