Drug discovery for periodontitis

Gingivitis or periodontitis (involving alveolar bone loss) is the major cause of tooth loss in adults [1]. It is most commonly associated with bacterial biofilm commonly known as plaque. The interactions between host defense mechanisms and plaque lead to plaque buildup. Poor dental hygiene, hormonal shifts in pregnancy, diabetes, human immunodeficiency virus, and some medication, such as phenytoin, calcium channel blockers, and cyclosporin, can further increase plaque buildup [2, 3]. Patients with periodontitis are at higher risks for cardiovascular diseases [4], low birth weight [5] among others [6].

Chronic periodontitis is the most common form of periodontitis, is plaque-induced and is a major cause of tooth loss [7]. Active bone loss can be triggered by changing oral bacteria flora. Porphyromonas gingivalis (P. gingivalis) is one of the common oral bacteria flora.

In this issue, the report by Ashwin Kumar R et al. [8] described a technique targeting prolyl tripeptidyl peptidase from P. gingivalis with bioactive compounds from Rosmarinus officinalis. The in silico technique is a newer process of discovery of drug candidates in the fields of medicine, biotechnology, and pharmacology. The potential medicinal compound has to be optimized to increase the affinity, selectivity, efficacy, metabolic stability, and bioavailability before the clinical trial process of this investigational new drug. Later, the compound has to go through several phases of animal and human testing following a very specific path established by the regulatory agencies to ensure that the drugs are safe and effective when approved for widespread use in humans. Pharmacovigilance mechanisms have to be in place to look for rare side effects which may not become evident in clinical trials.

Therefore, the discovery of new drugs for public health use involves a healthy interaction between scientists, academia, patent laws, and regulatory agencies. Prevention should be the primary strategy that is potentially the most cost-effective way to cope with this common disease. Some initial strategies should be adopted, such as oral hygiene, smoking cessation, and frequent oral examination, to identify the early lesion and early treatment.