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Experts to evaluate role of genetic testing in oral medicine

October 03, 2014

By Jean Williams

San Antonio — Is there predictive, chairside value in genetic testing in oral medicine? Ask a number of experts and you'll likely hear varied responses—some fairly simple, some rather complex.

Just such an opportunity is available Saturday, Oct. 11, from 8-9:30 a.m. at ADA 2014 -- America's Dental Meeting. Five notable experts will present on the topic for the Introduce Scientific Advances Into Your Clinical Practice forum—which is also worth continuing education credits for attendees. A Q&A session will follow.

"We're all different, from different trainings and different backgrounds," said panelist Dr. Jack Gunsolley, D.D.S.  "We're obviously talking about the same subject, but from very different viewpoints."

Dr_Jack_Gunsolley
Dr. Gunsolley
Dr_Scott_Diehl
Dr. Diehl
Dr_Thomas_Hart.
Dr. Hart
Dr_Ken_Kornman
Dr. Kornman
Dr_Peter_Polverini
Dr. Polverini
Dr_Michael_Glick
Dr. Glick
Dr_Dan_Meyer
Dr. Meyer
Dr. Gunsolley is director, Clinical Research Unit, Virginia Commonwealth University School of Dentistry. In debating the merits of genetic testing in oral medicine, he will join these colleagues:

  • Dr. Scott Diehl, Ph.D., professor in oral biology and health informatics at Rutgers University.
  • Dr. Thomas Hart, D.D.S., Ph.D., director of Craniofacial Population Sciences Research and a professor at the University of Illinois at Chicago in the Department of Periodontics. Dr. Hart is currently serving as Vice Chair of the ADA Council on Scientific Affairs, and will serve as Chair in 2015.
  • Dr. Ken Kornman, D.D.S., Ph.D., founder of Interleukin Genetics Inc.
  • Dr. Peter Polverini, D.D.S., professor of oral and maxillofacial pathology in the Department of Periodontics and Oral Medicine, Division of Oral Pathology/Medicine/Radiology at the University of Michigan School of Dentistry.

Dr. Michael Glick, editor of The Journal of the American Dental Association, and Dr. Daniel Meyer, ADA senior vice president for Science and Professional Affairs, will host the forum. The pair seeks a compelling and useful discourse on the topic in light of concerns in medicine and dentistry about the role of genetic testing.

"The National Institutes of Health has put together cross-teams from all disciplines to look at genetic testing and its relevance," Dr. Meyer said. "In the meantime, there have been some products that have been introduced into dentistry that are intended to screen patients based on genetic testing."

Added Dr. Glick, "In medicine, they call it personalized medicine. Here, we call it personalized dentistry or personalized dental care, meaning I can test you genetically and say, 'You need a cleaning, not every six months but every 12 months or maybe every 24 months based on genetic testing.' That's what's being done today, but we're not too sure the science justifies those types of recommendations yet. That's what this panel is all about."

Though the assembled panelists are unlikely to see eye to eye on the topic, they will set out to provide a frame of reference for dentists to judge for themselves the current science and clinical applications for genetic testing in oral medicine.

Dr. Diehl suggested that the discussion is one not to miss.  "The panel includes leading proponents of the alternative views of genetic testing, so we are very likely to witness a very stimulating and lively exchange," he said.

The point Dr. Diehl himself hopes to make?  "I believe there is great potential for genetic testing to be of substantial value for improving the diagnosis and treatment of oral and dental diseases," he said. "However, with the exception of rare syndromes, we do not yet have sufficient data to support doing so at the present time. Studies of thousands or tens of thousands of patients assessed using standardized clinical diagnoses, as has been done for a number of major medical disorders such as cancers, heart disease and diabetes, are likely to be needed in order to adequately understand the complex and heterogeneous etiology of conditions such as dental caries and periodontitis."

Dr. Diehl also said that the implications for how genetic testing in oral medicine affects insurance will likely come up.

For his part, Dr. Polverini says that he is cautious about the use of these tests. He hopes the discussion's value will be in "dispelling some myths about genetic testing and hopefully separate fact from fiction."

"Given the participants, the discussion will be lively and informative," Dr. Polverini said. "My personal view is there is a place for genetic testing, but one has to approach this new era of 'personalized oral health care' cautiously. There are clear examples where genetic testing has proven invaluable, i.e., predicting the onset of certain cancers and guiding targeted cancer therapy. However, with more complex diseases, including a number of common dental diseases, that involve multiple genes and gene interactions, the value of genetic testing is less obvious.

"Nonetheless, it is an exciting area that over time will prove to be part of the dental practitioner diagnostic and therapeutic tool box."

Dr. Gunsolley agrees that there may prove to be applications related to oral cancers, but he's not so certain about therapeutic applications for other dental diseases. "I think that the main applications are going to be in cancer-orientated areas," he said. "For more chronic diseases, like periodontal disease and caries, I don't think there's utility down the road. That's my hypothesis."

Dr. Ken Kornman, whose company Interleukin has a genetic test for periodontal disease on the market, says that the tests are indeed valuable to dentists.  "Genetic information has several clear places in oral medicine," he said. "It is still at an early phase of use, but it's pretty clear as to where it's going.

"It's possible today with genetic information that's available to identify patients who are at increased risk for severe periodontitis and use early preventive care to hopefully delay, slow down and ideally prevent completely those patients from getting severe periodontitis," he said.

But Dr. Hart would like to see heartier science behind the use of genetic testing in oral medicine. "While the FDA has begun to regulate some of these tests, the vast majority are not in fact regulated for clinical validity or clinical utility," he said. "It is important for clinicians and patients to understand the difference between different types of genetic tests so that they are aware of what tests can and cannot do. This discussion is overdue, but is complicated because most dentists receive relatively little formal education in human genetics in dental school and much of our understanding of how genetics contribute to common complex diseases and the single nucleotide polymorphisms tests behind these new tests has been developed in the last few years, after most of the dentists now practicing graduated. So they have not been formally educated in this area of genetics. This has created a lot of confusion.

"This discussion is a start in having a dialogue in the dental community regarding genetic testing, particularly for common complex traits such as periodontitis, and realistically discussing the potential and current limitations of such tests."

The free discussion (tickets required), CE course 7365, will take place in Room 214B in the Henry B. Gonzalez Convention Center. The course is open to dentists, educators, researchers, industry representatives, dental hygienists and dental assistants, who earn 1.5 hours of CE credits for attending.

The open forum, Introduce Scientific Advances Into Your Clinical Practice, is sponsored by the ADA Council on Scientific Affairs and The Journal of the American Dental Association with grant support from The Task Force on Design and Analysis.