Chronic inflammatory diseases are becoming increasingly important in Central Europe. The numbers of patients with allergies, diabetes, rheumatism, gastrointestinal or thyroid diseases, osteoporosis, cardiovascular diseases and periodontitis are increasing. Advances in medicine have reduced the complications of these diseases but not the number of patients who are diagnosed with them.
Fig.: Modified from Dr Pall (PhD), Department of Biochemistry Chair at the Washington State University ML.: Explaining ‘Unexplained Illnesses’.
Unlike acute inflammation which is a necessary response by our body to pathogenic invaders such as bacteria, viruses or fungi, chronic inflammation is almost always the result of an impaired immune tolerance. A healthy immune system is able to tolerate exogenous trigger factors and adjust inflammation to the level of the actual threat. The majority of chronic inflammatory diseases are a continued overreaction by the immune system to trigger factors which are usually harmless.
The figure shows most of the possible relevant triggers for a chronic inflammation and is intended to symbolise that one patient may often have several significant trigger factors which all simultaneously exert their effects. The trigger factors which are relevant for dentistry are marked in red.
Depending on the present exposure (load) and the individual stimulus thresholds (allergy? genetic predisposition?), the trigger factors which affect the body disrupt the regulatory tetrad made up of immune activation, oxidative and nitrosative stress, and mitochondrial function. This regulatory tetrad forms the bridge between endogenous and exogenous environmental factors and the impaired immune tolerance present with chronic inflammatory diseases.
Even dentists are increasingly confronted with patients who have chronic inflammatory diseases. This means that they are having to deal with patients with impaired immune tolerance. This is important because dentists in particular are required to permanently insert foreign materials into the bodies of their patients. The focus is on dental restoration materials in particular compared to environmental factors or foods because they exert their effects 24 hours a day, 7 days a week.
With an existing allergy, dental restorations made of metals, plastics or other materials act as trigger factors for centres of chronic inflammation in the mouth and jaw area. Even toxic metal loads or endogenous disruptive factors such as dead teeth, which are sources of mercaptans and thioether, are potential triggers of inflammations.
Preventive diagnostics is becoming increasingly important in this area. The options for diagnosing allergies and intolerances are presented in this brochure. Another focus is causality-related diagnostics for periodontitis and peri-implantitis which are constantly improving. New markers enable targeted therapy and monitoring of treatment outcomes.