ADA.org: Future of Dentistry Full Report

FUTURE OFDENTISTRY

manipulation to reduce the likelihood of the disease.
Recent research has suggested a possible association
between aphthous and herpes virus type 6 (HHV-6).
Specific HHV-6 IgM was detected in a significant per-
centage of patients with aphthous stomatitis. Also, high
levels of anti-HHV-6 antibody were found in patients
with lichen planus (Ghodratnama et al, 1999). The dis-
similarity of the two conditions notwithstanding, the
finding points to the need for additional studies to
define the role of the virus in both conditions.
Thalidomide is now available for treating major
aphthous stomatitis, especially that associated with
HIV infection (Jacobson, 2000). Data from a series
of studies suggested that a cytokine, tumor necrosis
factor-alpha (TNF-a), was a critical mechanistic
driver of the development of these large, persistent,
and highly symptomatic ulcers. Consequently, com-
pounds that were effective inhibitors of TNF-amay
prove to be an effective therapy.
There may be a relationship between lichen planus
and oral cancer. While the World Health Organization
defines oral lichen planus as a premalignant lesion, it
has been argued that only those lesions demonstrating
dysplasia are truly premalignant. A simple quantitative
comparison between the number of individuals with
lichen planus and the number with oral cancer intu-
itively seems to negate the hypothesis that all cases of
oral lichen planus are premalignant. The use of increas-
ingly sophisticated techniques, such as microsatellite
analysis in which oral lichen planus was evaluated for
loss of heterozygosity, are needed to ultimately resolve
this issue (Zhang et al, 1997).
One of the recent advances that may aid in the
faster diagnosis of oral HSV infection in immuno-
compromised patients involves in situ hybridization
of cytobrush smears using an automated smear
apparatus (Kobayashi et al, 1998). New treatment
and prevention modalities that are targeted to
immunocompromised patients are also emerging.
Low dose interferon alpha administered orally has
been successfully used to treat both animal and
human oral herpetic disease (Scalvenzi and Ceddia,
2000). In addition, certain advances have been
made in the vaccine development arena with the
most notable being the potentially protective immu-
nity generated with a vaccine based on the use of
attenuated Salmonella typhimuriumas an expres-
sion vector of HSV antigens (Karem et al, 1997).
Dentists will need to recognize infectious diseases
or immunocompromised states that show oral man-
ifestations. Various diagnostic tests have already

been developed which can assist the dentist in deter-

mining, chair-side, the presence of an herpetic or a

monilial infection. At present, these tests do not

seem to be in widespread use (Laga et al, 1993; and

Contreras et al, 1996). It is expected that there will

be more chair-side tests developed that will permit a

dentist to make a definitive diagnosis of an oppor-

tunistic infection, treat the infection and encourage

the dentist to arrange for an early referral for defin-

itive care by a medical specialist.

Furthermore, the greatest future threat to patients

will, in all likelihood, come from newly emerging infec-

tious diseases. As illustrated by the HIV pandemic

(Casiglia and Woo, 2000), a new human pathogen indi-

rectly led to the dramatic increase in previously recog-

nized oral infection (Candida albicans), as well as the

occurrence of previously unrecognized oral pathology,

including hairy leukoplakia (due to the Epstein-Barr

virus), linear gingival erythema and necrotizing ulcera-

tive periodontitis. The successful identification and

management by dentists of these emerging infections

will, as illustrated in the past, depend upon close col-

laboration between infectious disease specialists and

dental health care professionals.

There will be continuing developments and better

understanding of infectious disease control policies.

Research will no doubt lead to the availability of

new vaccines (Cho, 2000) similar to the Hepatitis B

vaccine now widely accepted by the dental profession.

There will be a more complete understanding of the

precautionary measures that can be taken to reduce

the infectious disease hazards of patients and members

of the dental team in the dental environment.

FUTURE CHANGES IN SALIVARY GLAND

DISEASES RESEARCH

The testing and introduction of secretogogues

with longer duration of action and fewer side effects

will occur in the near future. The development of

controlled-release formulations of these agents also

can be anticipated. Furthermore, improved anti-

inflammatory and immune-mediating agents are

expected, in the near future, that will be therapeutic

for SjØgren's syndrome and other salivary gland

inflammatory conditions. Examples include thalido-

mide derivatives that have immunomodulating activi-

ty without the devastating teratogenic side effects, and

new tolerance-inducing regimens that may markedly

reduce the incidence and severity of autoimmune con-

ditions. Both cytokine and anti-cytokine therapies are

Dental and Craniofacial Research