Microbiological test • Bacteria test
The use of antibiotics in connection with periodontal treatment has been greatly reduced, due to the serious problems with the development of resistant bacterial strains. But what if antibiotics are used more specifically as a kind of personal medicine after prior microbiological diagnostics? A study in 2020 has concluded that it cannot be recommended to base the use of antibiotics in periodontal treatment on microbiological studies. Periodontitis must continue to be treated mechanically as first choice. Antibiotics can only be considered if mechanical treatment fails in a patient with good oral hygiene. Microbiological sampling should be carried out if antibiotics have been given empirically in the past. (Source: Tandlægebladet 2/2020).
Microbiological sampling is carried out at the clinic if the antibiotics do not work as intended. Cultivation takes place in a laboratory in Copenhagen. The disadvantage is that some bacteria may be lost in the process. The price is relatively high (about DKK 3500+).
Previous tests before 2015 that are no longer used due to insufficient: Topas. Micro-IDent. Pocketwatch (SteriOss. Aspartate aminotransferase from tissue destruction in the pouch). DNA screening test (Bacteria are counted and evaluated. Genotype regarding IL-1A, IL-1B and IL-1 RN). Meridol (Real time PCR, 6 bacteria presence). MicroDentex DMDx (8 bacteria presence). PerioCheck (enzymes in the gum pocket). Evalusite (antigen for specific bacteria).
Genetic testing
There is no genetic test that can be used to assess an individual’s risk of high periodontal disease activity. Therefore, with the current knowledge, it is of course not in accordance with good clinical practice to offer the implementation of genetic testing to patients. Genetic testing of the subgingival microflora provides only modest information, the usefulness of which – with the possible exception of certain populations of African origin – is very limited. The ethical problems are linked to making healthy people sick, to the establishment of fear and to payment for a service that lacks a professional basis. Source: Tandlægebladet 30/1 2013)
In the years around 1997, adult patients could be tested (PST blood test with finger prick) for a gene marker Interleukin-1 genotype (IL-1A and IL-1B) as a prognosis indicator for severe periodontitis. All 3 factors IL-1, prostaglandin PGE2 and Matrix metalloproteinase MMP are enzymes that destroy collagen and bone. IL-1 is a cytokine that enhances PGE2 and MMP with the result that a lot of bone is destroyed.
The gene-positive reacted strongly to their own plaque in contrast to the gene-negative, had a 3-19 times greater risk of severe periodontitis and presumably made up about 30% of the American population.
Non-smokers and light smokers (<5 pack/year) with gene-positive had 3 times and heavy smokers (>20 pack/year) with gene-positive had 8 times greater risk of moderate/severe periodontitis than genotype-negative .
There was a suggestion that high production of IL1 was hereditary.
67% of patients with severe periodontitis tested positive for IL1 genotype. Gene-neg was dominant in periodontitis patients over 60 years and gene-pos was dominant in patients over 40 years. In other words, the test made sense in patients between 40-60 years old.
Implant: Genotype positive and age did not show more implant loss, but smoking gave 2.5 times more loss.
This PST test later proved not to be useful enough in relation to the price. Smoking itself has a far greater impact. Treatment is the same with and without testing.