>> Hi and welcome to Dentistry 101. Today, we're going to talk about periodontics. And we have here, Dr. Will Giannobile that he's the chair from the Department of Periodontics and Oral Medicine from the University of Michigan School of Dentistry. So Dr. Giannobile, it's a pleasure to have you hear today. >> Thank you so much, Dr. Castillo. I'm very happy to be here and to share my experience since as a periodontist. And so let's start by what is periodontics? Periodontist Is that discipline within dentistry as the name implies pareil means surrounding and don takes is the tooth. And so we look at all of those surrounding structures of the tooth and within the dentition. And so periodontics itself, we examine areas within the microbiota, the plaque biofilms that form under tooth root structures and looking at maintaining health within that oral microbiota and within the entire oral cavity. So we often times within the field, we look at the treatment of diseases of the surrounding structures. So the most common disease is called periodontal disease, which is a chronic infection caused by these bacteria that eventually leads to destruction of those surrounding tissues around the tooth. And so as periodontists, we are often times looking at ways that we can help maintain that health within the oral cavity. >> Okay and what is the periodontist and what is his role in terms of the procedures and treatments? >> So periodontists work within this healthcare delivery team in dentistry. We collaborate with many other specialists. It can be the orthodontist, general dentist, prosthodontist, restorative dentist and it's a collaborative care to provide the that treatment for patients who may have periodontal disease. Maintaining that health of the periodontium, all those surroundings structures. And so we look at ways to treat infections within the oral cavity. And so oftentimes, we are delivering care such as deep cleanings in collaboration with our dental hygiene colleagues and then looking at ways to treat the more advanced forms of the disease where often times surgical treatment is needed to reconstruct and rebuild. So oftentimes, we're using bone replacement grafts to rebuild that bone around the teeth. Sometimes we even do soft tissue grafts where we might transplant tissue from one part of the mouth to other areas around the mouth, surrounding to rebuild soft tissues or gum tissue around the teeth. Oftentimes, we'll work with an orthodontist. For example, a child might have an impacted tooth that can't come down into the oral cavity and we can often times do these surgical procedures to gain access to those teeth to then allow the orthodontist to bring those teeth down. As periodontist, another area that we're very involved in is implant dentistry. So if teeth or the dentition cannot be completely preserved and teeth need to be removed, we will work very closely with restorative dentists to then maybe rebuild that bone socket when the tooth has been lost and then place what are called tooth replacement dental implants or oral implants. And so these are prosthesis, very similar to a hip prosthesis where we are actually placing an osseointegrated titanium pin that replaces the tooth root and then we will work with a restorative dentist who will rebuild that crown around the tooth. So these are just a few examples of some of the things that a periodontist does. >> Okay, very interesting and what's the latest developments in this field? >> There are many different exciting areas within periodontics today. We talk about this field of personalized medicine, precision medicine where we customize therapies for our patients. So one of the interesting areas within perio is that we collaborate a lot with other healthcare professionals. So for example, oral, systemic issues. For example, cardiovascular disease could be rheumatoid arthritis. Other systemic diseases often times affect the oral cavity. And so as I come back to precision medicine, we're often times identifying either genetic markers or inflammation markers that are associated with these other diseases. So then we can customize our care for the patients to help identify these people who are maybe at higher risk for developing a more progressive or rapid type of periodontal disease. And then also allaying the fears of those individuals who might just need routine dental care, seeing their general dentist and dental hygienist. So the personalized medicine is an exciting area. In the field of regenerative medicine, tissue engineering, there are ways that we look at rebuilding those structures around the teeth. 3D printing, for example. We can take a cat scan of a patient of their jaws and then customize a replacement scaffold that might rebuild the bone around the teeth. So there are some clinical trials that we've been involved in where we can transplant stem cells from the patient that can populate these scaffold to rebuild the bone and rebuild the soft tissues around the teeth. And so that's been an exciting area within periodontics. One other growth area has been looking at drug delivery of chemotherapeutics. For example, antibiotics and patients that have these infections that are really localized around certain teeth. We can use these polymers that have a slow release system of either an antibiotic or something that maybe reduces the inflammation. And so this is an example of where we collaborate with dental hygienists where often times they may be delivering these in collaboration with the periodontist. >> Okay, very interesting and what's the horizon for the future of field of periodontics? >> I think that Dr. Castillo, if we look at the field and one of our, again, primary goals as periodontists is to preserve the dentition and maintain a state of health. And so if we can look at ways to create more predictable therapies for tooth preservation. And so as we look at the horizon as it relates to regenerative medicine, if we can develop these therapies that are more predictable to be able to preserve that periodontium, so we don't need to be removing as many teeth that could otherwise be saved. And so using these regenerative medicine approaches to rebuild the tissues or really block that progression of the disease process, I think. And oftentimes, be a good direction for us to be headed. >> I see and I know you have a very active research lab. So what are you researching now and where are you going with your research in terms of improving the peridontal tooth? >> Yeah, so we've been involved in three key areas. The first one has been looking at diagnostics to identify the disease. And so we've been looking at either genetic markers or some that are found from saliva, so we can do rapid prototype saliva diagnostic or it might take a small volume of saliva from a patient. And then we can analyze a whole myriad of different biomarkers of the disease process that might be associated with oral health or might be associated with systemic health and how those two come together. The second area is in that regenerative medicine space where we're looking at either using the 3D printing, stem cell biology or what we call growth factors. These are biologic agents. The body naturally produces and we can take those recombinant proteins and then deliver them to rebuild, either the gum tissue or the bone tissue. So much of this work that we've been doing has entered into clinical trials and is now available clinically for practitioners to use to treat their patients, and then the third area is looking at an area within dentistry call host modulation. And host modulation, it's the host the patient really taking advantage of the immune response of the patient to help controller and quite those cases where maybe a patient have an aggressive immune response and we can deliver agents that might help reduce that immune response. So there are many areas within osteoporosis research and in the arthritis areas where we're looking at drugs that have been helpful for patients with osteoporosis within the jaw bones. We've also been seeing that we can use some of these same agents to rebuild the bone and preserve it, either delivering it systemically or delivering it right around those pockets around the teeth themselves. And so these have been some active areas. We've had some of our dental students at the University of Michigan who've been very involved, as well as graduate students or visiting researchers from around the globe. >> And that's so very exciting, very interesting. Thank you so much for your time and thank you so much for watching. >> Okay, my pleasure.