5 Q&A with Professor Iain L. C. Chapple - Scientific Advisory Board Member 

To start, can you tell us about your professional background and what sparked your interest in dental health, particularly periodontal disease?

I graduated in 1986 and was keen to learn clinically, teach and undertake research. Therefore I trained dually as an academic researcher and educator with a PhD and clinically as a consultant working for the NHS. Periodontology is a fascinating discipline, with a mixed medical and surgical basis, and also a strong  biological background in which we can discover mainstream immune-inflammatory responses to microbial biofilm challenges, wound healing, behaviour change and many other complex interactions. The link with systemic non-communicable diseases is also very strong, opening up the whole of the body as a relevant area of exploration to improve health outcomes.
 

Your research highlights the role of saliva in early detection of periodontal disease. How widespread is this disease globally, and why is early detection so critical?

Periodontitis impacts 50% of adults worldwide and is the most common human inflammatory disease. Severe periodontitis impacts 13% of people. Two Economist White papers (2021 & 2024) highlight the global economic burden, and the human cost is also enormous in terms of years lost to disability (2021 Global Burden of Disease study – Lancet 2024).
 

Can you walk us through how periodontal disease is typically diagnosed and monitored? How accessible are saliva-based diagnostic tools to the general public today?

Diagnosis of periodontitis requires a formal clinical examination by a dental surgeon, which is a major challenge because only 50-60% of the population attend a dentist regularly in Europe and North America. There is a need for non-dental professionals such as physicians and pharmacists to be able to detect periodontitis and advise patients to seek formal diagnosis at a dental surgery, without the need to examine the mouth. The public have adapted to saliva testing during COVID-19 and therefore this route is optimal for non-dental professionals and the public. The first ever home HIV test was saliva based and remains so for public use.
 

There’s growing evidence linking periodontal disease to other serious conditions like diabetes and cardiovascular disease. Can you explain these connections and how periodontal health might serve as a window into broader systemic health issues?

The evidence based for periodontitis being linked to other systemic non-communicable diseases (NCDs) is very robust for diabetes control and complications, and also strong for cardiovascular diseases. This is evidenced in joint consensus papers by the European Federation of Periodontology (EFP) and the International Diabetes Federation (2019), World Heart Federation (2020) and World Organisation of Colleges and Associations of Family Doctors (2023 and 2024). The epidemiology is clear, the biological mechanisms are largely known and the impact of successful periodontal treatment on improved outcomes for diabetes and heart disease are known. Emerging evidence is also building for chronic kidney disease, rheumatoid arthritis and Alzheimer’s, as well as chronic respiratory diseases. The reason is that when gums bleed due to gingivitis or periodontitis, they do so because microscopic ulcers develop in the skin lining of the gums and these allow bacteria to enter the bloodstream. This fires off inflammation in the body and impacts insulin resistance, atherogenesis and many other processes that can contribute to systemic NCDs. In addition, some of those bacteria can enter the cells that line the blood vessels of the heart and cause endothelial dysfunction, and they can cross the blood-brain barrier and cause low level chronic inflammation in the brain.
 

What impact could greater access to saliva-based diagnostics have on public health? How might this technology change the way we detect and manage diseases in the future?

Saliva testing could be a “game changer”, as it would allow the public, or patients who don’t attend dentists to be tested for periodontitis and detected early. Early detection makes treatment very simple and very cheap (Economist Impact 2021) and once shown self care, patients can self-manage at home. Sadly, periodontitis is normally diagnosed at a very late stage, when damage has been done and it is harder and more expensive to treat. Dental teams are now starting to test assess for diabetes and high blood pressure – the reverse needs to happen with non-dental teams detecting periodontal diseases, but that can only happen with a test that does not require an oral examination.

"Saliva testing could be a 'game changer', as it would allow the public, or patients who don’t attend dentists to be tested for periodontitis and detected early. Early detection makes treatment very simple and very cheap ..."

Professor Iain L. C. Chapple,
Scientific Advisory Board Member - Magnasense AB