Interleukin 1 genetic tests provide no support for reduction of preventive dental care

• Published in: The Journal of the American Dental Association (1939) Vol. 146; no. 3; pp. 164 - 173.e4
• Main Authors: Diehl, Scott R., PhD, Kuo, Fengshen, MS, PhD, Hart, Thomas C., DDS, PhD
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.03.2015; American Dental Association
• Subjects: Adult; biomarker; clinical data reanalysis; Cytokines; Dental care; Dental Care - statistics & numerical data; Dentistry; Diabetes; Diabetes Complications - epidemiology; Female; Genetic Markers - genetics; Genetic Predisposition to Disease - genetics; Genetic screening; genetic test; Genetic testing; Genetic Testing - methods; Humans; Insurance Coverage; Insurance, Dental; Interleukin-1 - genetics; Male; Middle Aged; personalized medicine; Polymorphism, Single Nucleotide - genetics; preventive care; Preventive Medicine - methods; Risk Factors; single nucleotide polymorphism; Smoking; Smoking - adverse effects; Tooth Diseases - etiology; Tooth Diseases - genetics; tooth extraction; tooth loss; single nucleotide polymorphism; Han Chinese from Beijing; Vitamin D receptor; FCGR; clinical data reanalysis; Puerto Ricans; TNF; Genetic screening; Fc fragment of IgG, low affinity IIa or IIb, receptor; Caucasians from Utah; preventive care; Human leukocyte antigen; Interleukin 1; SNPs; genetic test; Single nucleotide polymorphisms; TLR; Toll-like receptor; Lactotransferrin; ASW; IL-1; VDR; biomarker; PUR; tooth extraction; tooth loss; personalized medicine; CEU; Tumor necrosis factor; CHB; HLA; African Americans from the Southwest; LTF
• ISSN: 0002-8177; 1943-4723
• DOI: 10.1016/j.adaj.2014.12.018

Abstract Background It has been proposed that the PST and PerioPredict genetic tests that are based on polymorphisms in interleukin 1 (IL-1) genes identify a subset of patients who experience fewer tooth extractions if provided with 2 annual preventive visits. Economic analyses indicate rationing preventive care to only “high-risk” genotypes, smokers, patients with diabetes, or combinations of these risk factors would reduce the cost of dental care by $4.8 billion annually in the United States. Methods Data presented in the study that claimed clinical utility for the PST and PerioPredict tests were obtained for reanalysis using logistic regression to assess whether the PST genetic test, smoking, diabetes, or number of preventive visits were risk factors for tooth extraction during a span of 16 years. Consistency of risk classification by the PST (version 1) and PerioPredict (version 2) genetic tests was evaluated in different ethnic groups from the 1000 Genomes database. Results Multivariate analyses revealed association of tooth extraction with diabetes ( P  < .0001), smoking ( P  < .0001), and number of preventive visits ( P  = .004), but no support for the PST genetic test ( P  = .96) nor indication that the benefit of 2 preventive visits was affected by this genetic test ( P  = .58). Classification of risk was highly inconsistent between the PST (version 1) and PerioPredict (version 2) genetic tests. Conclusions Two annual preventive visits were supported as beneficial for all patients, and there was no evidence that the IL-1 PST genetic test has any effect on tooth extraction risk or influences the benefits of 2 annual preventive visits. Practical Implications Neither IL-1 PST nor PerioPredict genetic tests are useful for rationing preventive dental care. Further research is needed to identify genetic biomarkers with robust clinical validity and clinical utility to effectively personalize the practice of dentistry.