|Year : 2022 | Volume
| Issue : 1 | Page : 24-28
Cognizance of precision dental medicine among Indian dentists
Milanjeet Kaur Raizada1, Ladu Singh Rajpurohit2, Jasmine Bhogal3
1 Department of Oral Medicine and Radiology, Panineeya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
2 Department of Public Health Dentistry, D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
3 Department of Public Health Dentistry, University of Warwick, Coventry, United Kingdom
|Date of Submission||16-Oct-2021|
|Date of Acceptance||11-Sep-2021|
|Date of Web Publication||06-Apr-2022|
Milanjeet Kaur Raizada
Department of Oral Medicine and Radiology, Panineeya Institute of Dental Sciences and Research Centre, Dilsukhnagar, Hyderabad - 500 060, Telangana
Source of Support: None, Conflict of Interest: None
Background: Dental care providers play a pivotal role in administering precision dental medicine (PDM) to their patients. Nevertheless, the lack of acquaintance about pharmacogenomics, proteomics, metabolomics, etc., may restrict the ability of dentists to advise patients or employ test results. The objective of the study was to evaluate the cognizance of PDM among Indian dentists. Materials and Methods: A cross-sectional questionnaire-based survey was designed. The questionnaire was sent to 500 Indian dentists through e-mail and social media. The results were analyzed by SPSS software version 19. Chi-square test was used to find the association between their qualifications/experience and knowledge of PDM. P < 0.05 was considered statistically significant. Results: Out of 500, 358 dentists reverted back to the questionnaire. While 122 (32%) dentists knew about this term, only one (0.81%) out of these 122 dentists used a biomarker assay and only one answered both the genomics-based questions correctly. Knowledge of PDM among dentists was independent of their qualifications or experience as suggested by results of Chi-square test (P > 0.05). Conclusion: Results of the study highlighted that knowledge about PDM is meager among practicing dentists in India. Nevertheless, all who knew about PDM understand its importance. Incorporation of PDM at undergraduate level will not only familiarize them but also motivate them to pick up this topic for research.
Keywords: Cross-sectional, dental education, genetics, genomics, knowledge, precision medicine, questionnaire
|How to cite this article:|
Raizada MK, Rajpurohit LS, Bhogal J. Cognizance of precision dental medicine among Indian dentists. J Dent Res Rev 2022;9:24-8
|How to cite this URL:|
Raizada MK, Rajpurohit LS, Bhogal J. Cognizance of precision dental medicine among Indian dentists. J Dent Res Rev [serial online] 2022 [cited 2022 Dec 3];9:24-8. Available from: https://www.jdrr.org/text.asp?2022/9/1/24/342702
| Introduction|| |
The dynamic and ever-evolving technology in the field of genomics and molecular biology has incited a paradigm shift, paving the way for “Precision Medicine/Personalized medicine.” According to the European Parliamentary Research Service, “precision medicine” is the use of scientific insights into the genetic and molecular basis of health and disease brought on by the sequencing of the human genome to guide decisions with regard to the prediction, prevention, diagnosis, and treatment of disease. Integrating the same concept while managing dental diseases led to the emergence of “Precision Dental Medicine” (PDM).
It is known for long that patients treated with same drugs for same disease exhibit different kinds of response and drug toxicity. Similarly, a virulent pathogen can bring up a range of symptoms in different patients. These discrepancies in the body's response can be ascribed to diverse factors of immune system, genetic makeup, drug metabolism, and environmental factors. For instance, administration of 5-fluorouracil, an anticancer drug, in patients' deficient of dihydropyrimidine dehydrogenase enzyme bring about severe toxic symptoms. Such disparities led to the origin of precision medicine or tailored treatment plan as per the patient's needs.
The concept of precision medicine emerged in early 2000 and Archibald E. Garrod is considered as the father of precision medicine. Since then, numerous studies have been published in dentistry, on genomics, salivaomics, proteomics, transcriptomics, metabolomics, and the microbiome.
Genomic basis of many oral diseases such as oral cancer, anodontia or hypodontia,, dental caries, and periodontal diseases, has been investigated in many studies in the past few decades along with molecular mechanism and signaling pathways involved in their etiopathogenesis. These molecular-level differences are used in diagnostic procedures such as assessing microbiome and infectious diseases from salivary samples and targeted during treatment by giving either precision medicine as in pharmacogenomics or with gene therapy or gene editing with CRISPR/Cas. Despite this, the cognizance about PDM remains unknown amid dentists. Hence, the aim of the study was to evaluate the awareness of PDM among dental practitioners in India.
| Methods|| |
A cross-sectional questionnaire-based survey was designed and was conducted over a period of 3 months. A questionnaire was developed consisting of succinct dichotomous, multiple-choice as well as open-ended questions in the English language. Content and face validity were done for the questionnaire, and Cronbach's alpha value was 0.82. CV ratio was 0.99 for all questions. Based on proportion, the sample size was calculated. Contact information of the dentists was taken from local dental associations and social dental communities. Dental surgeons who were not registered or not handling patients were excluded from the study, whereas registered dental surgeons were included in the study.
Questionnaire was then sent to 500 dentists through e-mail and social media (WhatsApp/Facebook messenger) including Head of the Departments/Associate Professors/Assistant Professors of various reputed dental colleges and dental practitioners all over India. After 1 week, a reminder message/mail was also sent to all those who did not responded.
Consent from all the participants was taken by clearly providing them with the basic essence of the theme/rationale of the survey before they actually took part in the study. They were informed that their identities and information will be kept confidential and were also told that they can withdraw from the survey responses at any point of time before officially reporting the survey results in any journal.
The questionnaire was divided into two sections and included total of 20 questions. The initial questions were related to their demographics, which included their qualifications (BDS, MDS, or PhD), place, years of experience, employment, or own practice details. In the second section, they were asked whether they were aware of the term PDM or not. Only those who were aware of the term were asked to complete the rest of the form. Questions related to their knowledge, perceptions, notions, practice, and opinions about PDM made rest of the questionnaire.
Data were extracted from the completed questionnaires and transferred into a digital file for data exploration. The Statistical Package for the Social Sciences version 19.0 (IBM - SPSS 19. Armonk, New York, United States) was used to analyze the data. Chi-square test was used to find the association between their qualification/experience and knowledge of PDM. P < 0.05 was considered statistically significant.
| Results|| |
Three hundred and fifty-eight (71.6%) out of 500 dentists participated in the study. Among these 358, 185 (51.6%) were BDS, 168 (46.9%) were MDS, and 5 (1.9%) completed their PhD. All the dentists who reciprocated were either practicing or were managing patients in dental colleges. They belonged to the different parts of India such as North India (Gurgaon, Delhi, Chandigarh, Karnal, Rohtak, Mohali, and Noida), Central India (Pune, Mumbai, Indore, and Udaipur), and South India (Hyderabad, Nellore, and Vishakhapatnam).
One hundred and eighty-five (51.6%) dental surgeons had experience of <10 years, 137 (38.26%) of them had experience between 10 and 20 years, and rest 36 (10%) had experience of >20 years. About 122 (34%) dentists were aware of the term PDM, and for rest 236 (65.9%) dental practitioners, this term was totally new. Hence, the latter group did not attempt rest of the questions. [Table 1] shows questions related to the relevance of precision medicine in dentistry with responses and frequency in percentage. One hundred and twenty-one (99.1%) dental practitioners answered that they have never used any genetic biomarker test for managing their patients to date, and only one (0.81%) dentist mentioned that he has used a salivary biomarker, i.e., BANA test for treating his patients suffering from halitosis. Only one (0.81%) dental practitioner answered both the questions related to genomics correctly and the rest 121 (99.1%) could answer only one question out of the two appropriately.
|Table 1: Questions and responses related to the relevance of precision medicine in dentistry|
Click here to view
Nevertheless, all of them (100%) accepted that more studies should be taken on PDM to make it a reality and PDM including topics on other fields such as genomics, proteomics, transcriptomics, and metabolomics pertaining to the scope of dentistry should be included in dental curricula.
To find the association between the qualification/experience of dentists and their knowledge about PDM, Chi-square test was used with closed-ended questions as shown in [Table 2]. P > 0.05 for all the questions proving that knowledge of PDM among dentists was independent of their qualifications or experience.
|Table 2: Association between qualification and experience of the dentists and their knowledge about precision dental medicine|
Click here to view
| Discussion|| |
In today's digital world, keeping one's knowledge abreast is imperative. This may sound quite apparent, but the results of our study prove otherwise.
In the west, after signing of bipartisan precision medicine initiative in 2015, the dental schools of North America have started including PDM as a part of didactic or clinical level in either the predoctoral or postgraduate/resident curricula. However, in India, only 34% of dental practitioners knew about it. A comparative evaluation with other studies was not possible as it is the first study of its kind.
Although the terms “personalized medicine” and “precision medicine” are considered synonymous and used interchangeably by many, a subtle difference exists between them. The former refers to a medical treatment customized specifically for an individual, whereas the latter refers to tailoring the medical treatment for a group of individuals. The formulation of medicines specifically for an individual is impractical. Therefore, the NRC Council Report of 2011 suggests that the term “precision medicine” should be preferred over “personalized medicine.”Similarly, in dentistry too authors suggest that the term “precision dental medicine” should be adopted as introduced by Schwentke F2 rather than “personalized dental medicine,”, although the latter is far more commonly used.
A report by “new models of dental education” implicated that the study of genetics pertinent to dentistry should be introduced in undergraduate and postgraduate curricula. E.g. screening of genes, transcription, or etiologic factors (human papillomavirus) for head-and-neck cancers biomarkers associated with increased caries-associated microbe growth; proline-rich proteins, human neutrophil defensins, secretory immunoglobulin, mucin, gene mutations like parathyroid hormone receptor 1 in tooth development, cytochrome P variants, anesthesia metabolism and pain perception in orofacial pain, interleukin-1 (+3953) allele 1 in external apical root resorption, dental stem cells in regenerative medicine and therapeutics and plasminogen in periodontitis.
PDM has application in all branches of dentistry and is not limited to only a few of them., However, the penchant of human beings to resist change and be in their comfort zone is a notable impediment to introduce PDM and the related information of genomics, proteomics, transcriptomics, metabolomics, pharmacogenomics, etc., in dental curricula along with curriculum crowding. It will further need acclimatization to upgrade the conventional way how dentistry is perceived.
PDM is a science of near future with more and more upcoming DNA laboratories and companies venturing rapid diagnostic kits. Zheng et al. have listed a few genetic-based and nongenetics-based diagnostic tests, which are already on the market in the west, for example, periopredict, perirx salimark for oral squamous cell carcinoma, salivary DNA tests, cariscreen testing meter, advanced tear diagnostics, saliva-check SM, and dentocult strip mutans. Consecutively, all these investigations will become more and more cost effective with increasing demand.
Flores et al. have long advocated a vision of medicine that is predictive, preventive, personalized, and participatory (P4) where self-monitoring and self-assessments form the participatory elements. Now, a new component, i.e., psychocognitive leading to P5 system in medicine is also been proposed. Psychological health is seen as an essential facet of personal well-being and needs to be incorporated in domain of dentistry as well, considering that numerous diseases related to oral cavity have psychological component in it making it worse. Stratified random sampling was not done, and this could be considered the limitation of the study. More studies should be planned including international dentists as well for better assessment.
| Conclusion|| |
In the current settings, our results have highlighted that the majority of the dental practitioners in India are unacquainted about this concept of PDM, but all the respondents who were informed about PDM, fathom its importance. None of the dental colleges in India has taken up this initiative of introducing PDM at didactic or clinical level. Future implications – embodiment of this topic at undergraduate level will not only train them but also motivate them to pick up this topic for research during their postgraduation and PhD in respected streams. Faculty training, continued dental education programs and seminars integrating the basic concepts of genomics and PDM, should be arranged for general dental practitioners as well. Consecutively, this will aid in the growth and application of precision medicine in dentistry.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Di Sanzo M, Cipolloni L, Borro M, La Russa R, Santurro A, Scopetti M, et al.
Clinical applications of personalized medicine: A new paradigm and challenge. Curr Pharm Biotechnol 2017;18:194-203.
Bragazzi NL. Rethinking psychiatry with OMICS science in the age of personalized P5 medicine: Ready for psychiatome? Philos Ethics Humanit Med 2013;8:4.
Shastry BS. Pharmacogenetics and the concept of individualized medicine. Pharmacogenomics J 2006;6:16-21.
Longdon B, Hadfield JD, Day JP, Smith SC, McGonigle JE, Cogni R, et al.
The causes and consequences of changes in virulence following pathogen host shifts. PLoS Pathog 2015;11:e1004728.
Baek JH, Kim JG, Kim SN, Kim DH, Sohn SK, Hong YJ, et al.
Unpredicted severe toxicity after 5-fluorouracil treatment due to dihydropyrimidine dehydrogenase deficiency. Korean J Intern Med 2006;21:43-5.
Sugeir S, Naylor S. Critical care and personalized or precision medicine: Who needs whom? J Crit Care 2018;43:401-5.
Perlman RL, Govindaraju DR. Archibald E. Garrod: The father of precision medicine. Genet Med 2016;18:1088-9.
Glurich I, Acharya A, Brilliant MH, Shukla SK. Progress in oral personalized medicine: contribution of 'omics'. J Oral Microbiol 2015;7:28223.
Wong DT. Salivomics. J Am Dent Assoc 2012;143:19S-24.
Shukla SK, Murali NS, Brilliant MH. Personalized medicine going precise: From genomics to microbiomics. Trends Mol Med 2015;21:461-2.
Duran-Pinedo AE, Chen T, Tele R, Starr JR, Wang X, Krishnan K, et al
. Community-wide transcriptome of the oral microbiome in subjects with and without periodontitis. ISME J 2014;8:1659-72.
Lesseur C, Diergaarde B, Olshan AF, Wünsch-Filho V, Ness AR, Liu G, et al.
Genome-wide association analyses identify new susceptibility loci for oral cavity and pharyngeal cancer. Nat Genet 2016;48:1544-50.
Witkop CJ. Genetics and dentistry. Eugen Quart 1958;5:15-22.
Divaris K. Precision dentistry in early childhood: The central role of genomics. Dent Clin North Am 2017;61:619-25.
Mansbridge JN. Heredity and dental caries. J Dent Res 1959;38:337-47.
Gorlin RJ, Stallard RE, Shapiro BL. Genetics and periodontal disease. J Periodontol 1967;38:5-10.
Kornman KS, Crane A, Wang HY, di Giovine FS, Newman MG, Pirk FW, et al
. The interleukin-1 geno-type as a severity factor in adult periodontal disease. J Clin Periodontol 1997;24:72-7.
Yoshizawa JM, Schafer CA, Schafer JJ, Farrell JJ, Paster BJ, Wong DT. Salivary biomarkers: Toward future clinical and diagnostic utilities. Clin Microbiol Rev 2013;26:781-91.
Divaris K. The era of the genome and dental medicine. J Dent Res 2019;98:949-55.
Kozlovsky A, Gordon D, Gelernter I, Loesche WJ, Rosenberg M. Correlation between the BANA test and oral malodor parameters. J Dent Res 1994;73:1036-42.
Hupp JR. Precision medicine – Implications for oral-maxillofacial surgery. J Oral Maxillofac Surg 2015;73:795-6.
Zheng LY, Rifkin BR, Spielman AI, London L, London SD. The teaching of personalized dentistry in North American dental schools: Changes from 2014 to 2017. J Dent Educ 2019;83:1065-75.
Johnson L, Genco RJ, Damsky C, Haden NK, Hart S, Hart TC, et al.
Genetics and its implications for clinical dental practice and education: Report of panel 3 of the Macy study. J Dent Educ 2008;72:86-94.
Ting S, Schug S. The pharmacogenomics of pain management: Prospects for personalized medicine. J Pain Res 2016;9:49-56.
Kobayashi K, Hisamatsu K, Suzui N, Hara A, Tomita H, Miyazaki T. A review of HPV-related head and neck cancer. J Clin Med 2018;7:E241.
Levine M. Susceptibility to dental caries and the salivary proline-rich proteins. Int J Dent 2011;2011:953412.
Tao R, Jurevic RJ, Coulton KK, Tsutsui MT, Roberts MC, Kimball JR, et al.
Salivary antimicrobial peptide expression and dental caries experience in children. Antimicrob Agents Chemother 2005;49:3883-8.
Haeri-Araghi H, Zarabadipour M, Safarzadeh-Khosroshahi S, Mirzadeh M. Evaluating the relationship between dental caries number and salivary level of IgA in adults. J Clin Exp Dent 2018;10:e66-9.
Gabryel-Porowska H, Gornowicz A, Bielawska A, Wójcicka A, Maciorkowska E, Grabowska SZ, et al.
Mucin levels in saliva of adolescents with dental caries. Med Sci Monit 2014;20:72-7.
Subramanian H, Döring F, Kollert S, Rukoyatkina N, Sturm J, Gambaryan S, et al
. PTH1R mutants found in patients with primary failure of tooth eruption disrupt g-protein signaling. PLoS One 2016;11:e0167033.
Gülden N, Eggermann T, Zerres K, Beer M, Meinelt A, Diedrich P. Interleukin-1 polymorphisms in relation to external apical root resorption (EARR). J Orofac Orthop 2009;70:20-38.
Bansal R, Jain A. Current overview on dental stem cells applications in regenerative dentistry. J Nat Sci Biol Med 2015;6:29-34.
Sulniute R, Lindh T, Wilczynska M, Li J, Ny T. Plasmin is essential in preventing periodontitis in mice. Am J Pathol 2011;179:819-28.
Reddy MS, Shetty SR, Vannala V. Embracing personalized medicine in dentistry. J Pharm Bioallied Sci 2019;11:S92-6.
Divaris K. Fundamentals of precision medicine. Compend Contin Educ Dent 2017;38:30-2.
Schloss AJ, Verjee Z, Spielman AI. The era of personalized dentistry is upon us: It's time to include it in dental curricula. J Dent Educ 2017;81:363-5.
Flores M, Glusman G, Brogaard K, Price ND, Hood L. P4 medicine: How systems medicine will transform the healthcare sector and society. Per Med 2013;10:565-76.
[Table 1], [Table 2]