PET-Test - PET test: pathogen test for periodontitis or peri-implantitis

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What is
How can periodontitis be

For healthcare professionals:

MIP Pharma GmbH

For healthcare professionals
Tel.: 0049-06894/ 971-238
Fax: 0049-06894/ 9712004-233

Why is the
PET test important?
How is the PET test
What is periodontitis?
When the gums are chronically inflamed…
Periodontitis is advanced chronic inflammation of the gums and it is primarily an infectious disease. For this reason, it can also have an effect on the whole organism and it can influence e.g. cardiovascular disease and diabetes.

Certain bacteria in plaque cause an inflammatory reaction, which results in not only the gums, but also the periodontium and the surrounding bone being affected.

Targeted and permanent treatment is very important to ensure that the gums do not recede any further and to make sure that the teeth do not become loose or even fall out! For this purpose, the periodontitis pathogens must be removed or at least clearly reduced and the inflammatory reactions must be stopped.

Peri-implantitis is inflammation of the mucous membrane and the bone surrounding a dental implant, which can result in the loss of the implant unless targeted treatment is provided. Very similar causes and disease mechanisms, as in periodontitis, are also present in this case, so many of the diagnostic and therapeutic principles are transferable.

How does periodontitis occur?
If plaque is not adequately removed from the edges of the gums, certain periodontitis-causing bacteria can colonise this area. These bacteria release toxins, which can result in an inflammatory reaction in the body. If the bacteria become permanently present without being removed, the inflammation becomes chronic.

This results in the destruction of gum tissue and the formation of periodontal pockets. The gums become red and swollen and they bleed occasionally, e.g. when cleaning the teeth. They clearly recede, so the teeth are not covered by the gums as much.

If the periodontal pockets become deeper, the apparatus for holding the teeth (periodontium) is also affected and there is decomposition of the jawbone: the teeth become loose and could get lost!
When is there an increased risk of developing periodontitis?
The development and progression of periodontitis are affected by a whole series of different factors. The latter can, for example, include hereditary factors and general diseases such as diabetes mellitus. However, they can also include an unhealthy diet, increased stress and, above all, smoking.

For this reason, periodontal disease can follow a very different course in different people. For example, it can progress slowly, it can occur in episodes or it can even occur suddenly and progress rapidly.

In the case of patients who have severe forms of the disease or who do not respond to the usual treatment, particularly aggressive periodontal bacteria are usually present.
How can periodontitis be treated?
Effective cleaning is of the utmost importance!
In order to prevent a visible receding of the gums and the loosening of teeth, targeted treatment is provided: The periodontal pathogens must be removed or considerably reduced in number and the inflammatory reactions must be stopped!

For this purpose, the visible surfaces of the teeth are initially professionally cleaned in the dental practice. Patients are then shown how to improve their daily oral hygiene by adopting the correct teeth cleaning techniques, conscientiously cleaning the spaces between the teeth and using mouth washes.

This consistent and effective oral hygiene is a basic requirement for further treatment and it provides patients with an important opportunity for making sure that their treatment is as successful as possible!

At the end of this phase, the plaque with the bacteria and toxins which it contains is removed as part of the dental mechanical treatment of periodontitis. By using special cleaning tools, this plaque is also removed from the surface of the roots of the teeth and thus from the periodontal pockets, as toothbrushes cannot reach there. Sometimes an antibiotic has to be taken additionally.
Why are "biofilm" and periodontal pockets so significant?
Periodontal pathogens form networks in the developing periodontal pockets without being disturbed. This "biofilm" protects them from the body’s defence cells and also from the effect of antibiotics. For this reason, periodontitis will not disappear of its own accord without dental treatment which involves mechanical disruption of the biofilm.

Some periodontal pathogens are not only present in plaque, but can penetrate deep into the tissue of the gums. They "hide" in the tissue and so they are not adequately caught by dental cleaning tools.

These pathogens which invade the tissue are particularly responsible for causing damage to the gums. In such cases, precisely tailored antibiotic treatment which definitely kills these pathogenic germs is required.
When is antibiotic treatment necessary?
Dental and periodontal associations recommend antibiotics supportive to mechanical therapy in the case of advanced periodontitis and severe, aggressive and rapidly advancing forms of the disease.

Having an exact knowledge of the underlying pathogens will avoid under- or overtreatment and is an important pillar of successful treatment!

If certain underlying diseases such as diabetes mellitus are present or if previous treatment has not been successful, it can also be necessary to take antibiotics. In such cases, it is often a matter of periodontal pathogens invading the gum tissue.

The same applies here: antibiotic therapy by itself will not be adequate without additional mechanical cleaning as the presence of an intact biofilm in the periodontal pockets protects the bacteria against antibiotics!
Why is the  PET test important?
Individual identification of pathogens for successful treatment
The PET test is a very modern and accurate technique for the accurate determination of periodontal pathogens. This means that individual and optimal treatment can be provided to you as the patient, so that treatment can be as successful as possible!

In the case of periodontitis or peri-implantitis, there is a range of different pathogens which show varying degrees of aggressivity and which respond to different antibiotics. For this reason, the professional associations and your dentist will recommend that particular tests will be performed for the detection of periodontal pathogens.

By using the PET test, the causative pathogens will be able to be detected in every individual patient and, where necessary, can therefore be specifically destroyed with the right antibiotics.

For you as the patient, this means that you will only need to take an antibiotic if this has been shown to be necessary. With the PET result, your dentist will receive an individually compiled list showing which antibiotic is appropriate in your case and whether you require a combination of two different antibiotics.
Restoration of the symbiotic equilibrium
The achievement of a biological equilibrium between the more than 500 usually harmless types of bacteria in the mouth is very important and can only be permanently restored by the targeted and preferably complete removal of periodontal pathogens.

For this reason, the highly sensitive PET test is used to determine the exact ratio of individual periodontal pathogens to harmless oral bacteria. This provides important information about whether an antibiotic is necessary for the restoration of the symbiotic balance and, if it is, which antibiotic is the most likely to be effective in this case.
A very problematic pathogen
The very aggressive pathogen Aggregatibacter actinomycetemcomitans (Aa) is particularly problematical, partly because it is difficult to detect and can only be eliminated by very targeted antibiotic therapy.

If other, naturally present bacteria are not available to act as its "counterparts", the aggressive pathogen can spread considerably in some patients and can result in progression of the disease.

Aa is able to hide deep in the periodontal pockets and it invades the tissue. Consequently, the pathogen will not be adequately detected by most test systems, as it is often only present in quite small amounts in the samples which are taken.

However, the highly sensitive PET test can detect even very small amounts of Aa with certainty. Your dentist will then be able to introduce a very targeted treatment to destroy this aggressive pathogen.
How is the  PET test performed?
Highly sensitive determination of pathogens
The highly accurate PET test is performed in the dental practice for the accurate detection of the causative pathogens of periodontitis and peri-implantitis and for an assessment of their significance with regard to the important symbiotic equilibrium.

For this purpose, samples of plaque are taken from the periodontal pockets or affected implants of patients with the use of small paper tips. These samples of plaque, which are not sensitive to the effects of transportation, are then sent to MIP Pharma’s very modern specialised laboratory.

A highly sensitive molecular biology technique known as real-time PCR is used in the case of every individual sample. With this method, the genetic material (the DNA) of the bacteria which it contains is examined in many complicated individual steps.

The PET test shows exactly which periodontal pathogens are present in the sample. The ratio of the different pathogens is also determined in order to obtain important information. The reason for this is that, while it is the case that some pathogens only pose a risk where they are present in higher numbers or where they co-exist with other pathogens, others can result in disease progression even when they are only present in small quantities!
The PET result: your individually tailored treatment
The detailed results of the PET test are immediately sent to the treating dentist by the specialised laboratory of MIP Pharma. The results include not only a qualitative and quantitative assessment of the detected pathogens; they also include patient-individual treatment recommendations.

With the PET result, your dentist will be able to provide effective and sustainable periodontal treatment which is tailored to your personal situation.

Thus, the PET test provides an important basis for optimal periodontal treatment and has been used more than 100,000 times!

Unfortunately, the costs of this important test are still not reimbursed by most health insurance funds.
Where to go from here?
After completion of the first phase of periodontal treatment, your dentist maybe will recommend another test to check for pathogens (e.g. after 8-12 weeks) depending on the particular situation.

The purpose of the new PET test will be to check whether the treatment has had the desired effect on the pathogens. Any recurrences will also be able to be detected early as the risk of this chronic disease will continue to be increased for lifetime.

Periodontal treatment together with the determination of causative pathogens with the PET test, permanent and optimal oral hygiene as well as regular dental check-ups will constitute the important basis of your future oral health.

We would like to wish you all the best!

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