Study reveals new aspects of gingivitis and the body’s response

dental plaque inflammation
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US researchers for the first time have identified and classified how different people respond to the accumulation of dental plaque, the sticky biofilm that gathers on teeth. 

Their work, recently published in the journal Proceedings of the National Academy of Sciences (PNAS), sheds important new light on why some people may be more prone to serious conditions that lead to tooth loss and other problems.

The researchers, led by a team at the University of Washington School of Dentistry, also found a previously unidentified range of inflammatory responses to bacterial accumulation in the mouth. When bacteria build up on tooth surfaces, it generates inflammation, a tool the body uses to tamp down the build-up. Previously, there were two known major oral inflammation phenotypes: a high or strong clinical response and a low clinical response. The team identified a third phenotype, which they called “slow”: a delayed strong inflammatory response in the wake of the bacterial build-up.

The study revealed for the first time that subjects with low clinical response also demonstrated a low inflammatory response for a wide variety of inflammation signals. 

The study authors wrote that understanding the variations in gum inflammation could help better identify people at elevated risk of periodontitis. In addition, it is possible that this variation in the inflammatory response among the human population may be related to susceptibility to other chronic bacterial-associated inflammatory conditions such as inflammatory bowel disease.

In addition, the researchers found a novel protective response by the body, triggered by plaque accumulation, that can save tissue and bone during inflammation. This mechanism, which was apparent among all three phenotypes, utilises white blood cells known as neutrophils. In the mouth, they act something like cops on the beat, patrolling and regulating the bacterial population to maintain a stable condition known as healthy homeostasis.

In this instance, plaque is not a villain. To the contrary, the researchers said that the proper amount and make-up of plaque supports normal tissue function. 

When healthy homeostasis exists and everything is working right, the neutrophils promote colonisation resistance, a low-level protective inflammatory response that helps the mouth fend off an excess of unhealthy bacteria and resist infection. At the same time, the neutrophils help ensure the proper microbial composition for normal periodontal bone and tissue function.

The researchers’ findings underscore why dentists preach the virtues of regular brushing and flossing, which prevent too much plaque build-up. 

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