Is it really in their genes?
Many health conditions are linked to our genes. In fact, genetic make-up is associated with risk of developing various diseases from breast cancer to type 1 diabetes. But how can genetics impact people’s oral health and how can you use this to tailor the dental care you provide?
Dental caries and periodontitis
A 2019 meta-analysis supported the idea that genetics may play a role in risk of dental caries and periodontitis.[i] It also highlighted that additional factors such as smoking, education and personality traits had an influence. In contrast, another study published this year concluded that genetics were not to blame for dental caries risk.[ii] It compared dental caries and enamel defects in 345 6-year-old twins. The results showed no correlation in the oral health condition of each twin, with the authors suggesting that environmental factors were more influential than genetic.
Interestingly, other study authors have suggested that the genetic contribution reduces as we age. For instance, some postulated a 50:50 influence of genetic and environmental factors in young children, decreasing to 25% contribution of genetics in adults. We still need more research to better understand the impact of genetics on risk of oral health problems.[iii]
Cleft lip and palate
However, there are situations where a patient’s genetics do affect the condition of the oral cavity. For example, specific genes have been associated with cleft lip and palate.[iv] The condition is a congenital deformity caused by abnormal development during gestation. Consequently, it can result from a single gene defect (Mendelian disorder), structural abnormalities in the chromosomes or multiple genetic mutations.[v] In many cases, cleft lip and palate is associated with a clinically recognised syndrome.
There are many genetic disorders affecting the global population. Examples would include arrhythmias, cystic fibrosis, Down’s syndrome, Huntington’s disease, muscular dystrophy and sickle cell disease, among others. In the UK, 10% of patients in primary care have a condition with a genetic component.[vi]
For the dental team, it’s important to be aware of how these conditions effect oral health. For instance, children with cystic fibrosis are more prone to enamel defects and calculus accumulation.[vii] Those with Down’s syndrome are at a high risk of bruxism ad periodontal disease.[viii] In addition, oral complications linked with sickle cell disease include mucosal lesions, delayed dental eruption, bone pain and oral neuropathies.[ix] Subsequently, understanding these patients’ risks of dental problems will help dental professionals provide the bespoke support these patients need.
Furthermore, some genetic conditions will impact a patient’s ability to perform oral hygiene routines effectively. As a result, their oral health may suffer. Being able to tailor dental hygiene advice and recommendations accordingly will encourage improved outcomes.
Jeans for Genes!
This year’s Jeans for Genes campaign will be on 16th-20th September. It aims to raise awareness of genetic disorders and collect donations to fund continued research and facilities for those affected. Whether you wear jeans for a day or organise other fundraising activities, you can easily get involved.
[ii] Silva MJ, Kilpatrick NM, Craig JM, Manton DJ, Leong P, Burgner DP, Scurrah KJ. Genetic and early-life environmental influences on dental caries risk: A twin study. Pediatrics. May 2019; 143(5). DOI: 10.1542/peds.2018-3499
[iii] European federation of Periodontology. Perio Insight 4. Summer 2017. https://www.efp.org/publications/perioinsight/perioinsight04/ [Accessed August 2019]
[iv] Kohli SS, Kohli VS. A comprehensive review of the genetic basis of cleft lip and palate. J Oral Maxillofac Pathol. 2012;16(1):64–72. doi:10.4103/0973-029X.92976
[v] Cobourne MT. The complex genetics of cleft lip and palate. European Journal of Orthodontics. 2004;26(1); 7-16
[vi] The Newcastle upon Tyne Hospitals. NHS Foundation Trust. Northern Genetics Service. Common Genetic Conditions. http://www.newcastle-hospitals.org.uk/services/ng_npcg_common.aspx [Accessed August 2019]
[vii] Narang A, Maguire A, Nunn JH, Bush A. Oral health and related factors in cystic fibrosis and other chronic respiratory disorders. BMJ Journals. Archives of Disease in Childhood 2003;88; 702-707
[viii] Areias C, Sampaio-Maia B, Macho V, Macedo P, Casimiro e Andrade D. oral health in Down Syndrome. Health Problems in Down Syndrome. Edited by Subrata Dey. DOI: 10.5772/60652