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Amila Zukanovic DDM, MSc, PhD
Dr Banasova, how did you become interested in dentistry and what led you to researching oxidative stress?
My mum is also a dentist and I spent lots of time with her in her office as a child. Actually, she was the one person who did not want me to study dentistry, and now I understand why. She understood that dentistry is not an easy profession. Nonetheless, I can say today that watching her doing her job with passion was what motivated me to study dentistry.
The topic of my PhD thesis was periodontitis and oxidative stress markers. I must say that it was quite difficult in the beginning, because there were not enough studies in this field at the time, but as my colleagues and I achieved good results in the clinical research and proved our hypotheses, I got more and more into it. I am currently finishing a master’s degree in oral implantology in Italy and I am writing my thesis on peri-implantitis and oxidative stress markers, so I am still continuing with the topic.
Could you explain to our readers what oxidative stress is? What happens in our bodies when this takes place?
Oxidative stress is an imbalance of free radicals and antioxidants in the body, which can lead to cell and tissue damage. On the one hand, this occurs naturally and plays a role in the ageing process; on the other hand, a large body of scientific evidence suggests that long-term oxidative stress contributes to the development of a range of chronic conditions. Such conditions include cancer, diabetes, heart disease, atherosclerosis, Parkinson’s disease, periodontitis and many other diseases.
What role does it play in inflammation? What is the link between oxidative stress and periodontal disease?
The body’s natural immune response can trigger oxidative stress temporarily. This type of oxidative stress causes mild inflammation that goes away after the immune system fights off an infection or repairs an injury.
Uncontrolled oxidative stress can accelerate the ageing process and may contribute to the development of a number of conditions which I mentioned earlier. Oxidative stress is involved in the pathogenesis of periodontitis as well.
Could patients identify risk factors or find ways to avoid or reduce oxidative stress?
Several risk factors contribute to oxidative stress and excess free radical production. These can include diet; lack of exercise; smoking; alcohol consumption; certain conditions, such as obesity; medications; and environmental factors, such as pollution and radiation.
While you can’t completely avoid exposure to free radicals, you can make lifestyle choices regarding your diet, exercise, environment and so on to help keep your body in balance and prevent damage and disease. And this includes your oral health as well—and, I would say, patients are still not aware enough of how important oral health is for their general health. During recent years, we have seen a rise in oral disease related to oxidative stress.
How familiar is the average dental professional with oxidative stress, though? Is it considered during diagnosis or treatment?
All dentists know that oral health is an important aspect of overall well-being and that numerous systemic conditions and diseases have oral origins, but I think the link between oral disease and oxidative stress is still not that widely known. To give you an example: at the level of the oral cavity, saliva acts as the first line of defence against free radicals through antioxidants, and in the event of an infection, increased generation of free radicals means they outnumber antioxidants to initiate oxidative stress. However, I have noticed that there are more and more studies and articles in the area of medicine and also in the field of dentistry that are mentioning oxidative stress.
During diagnosis, patients’ general condition and potential oxidative stress causes should be considered. Smoking for example is regarded as one of the most significant risk factors for the development of periodontitis, as it can affect the alveoli, resulting in tooth loss, but it can also increase oxidative stress. And in the end, it is a risk factor that can be eliminated.
Are you familiar with bioflavonoids and the role they can play in oral health?
Bioflavonoids are natural sources of medicine, are said to have antibacterial and anti-inflammatory or antioxidant properties, and stimulate the immune system. They neutralise viruses by stimulating white blood cells and lymphocytes and produce interferon, thereby stimulating the immune system. They are widely used in dentistry as an additional treatment after professional care, and they have many clinical benefits in other medical fields too.
CURAPROX's Perio Plus+ contains CITROX, which is a mix of different bioflavonoids that act as antioxidants. Do you see potential for this in oral health products?
CITROX is an antimicrobial whose components consist of soluble bioflavonoids derived from citrus fruits. Bioflavonoids are hydroxylated phenolic structures synthesised by plants and have previously been shown to act against bacteria, fungi and viruses. As we know, bacteria are the main cause of periodontal diseases. Many recent studies have demonstrated that CITROX is effective in inhibiting the growth of a range of bacteria, such as Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, the main actors in pathogenic flora in patients with periodontitis.
I see CITROX’s potential as an addition to oral health products, and it is already being used in this way. However, it does not replace professional care. There has to be a proper protocol on treating the periodontitis by a dental professional first. Products containing chlorhexidine with other antioxidants are the best supplements to help patients reduce oral bacteria at home—of course, according to the dentist’s instructions. When we treat periodontitis properly and the patient is compliant at home, the combination of providing optimal oral hygiene and these antimicrobial agents allows for a massive decrease in harmful bacteria in the oral cavity, an improvement of periodontal status and the stabilisation of oral health. As such, markers of oxidative stress can be reduced rapidly.
Lastly, has your research on the topic changed the way you treat patients or see periodontal disease?
I already mentioned that numerous clinical and basic experimental studies have shown a strong association between oxidative stress and periodontitis. Getting a better understanding of this association gave me a deeper insight into the pathogenesis of periodontitis, the relationship between periodontitis and systemic inflammation, and therapeutic strategies. Also, all dentists should know that periodontal treatment should be taken seriously not only to keep the patient’s mouth as healthy as possible but also in order to prevent other serious complications.