On the Future of Continuous Monitoring for Personalized Oral Medicine (part 2)

What are some of the most promising new or futuristic technologies that could improve oral health?

There are at least three directions in which current and developing technologies could help improve oral health: 1) analysis of dense data at individual and population level e.g. dense data analysis by artificial intelligence (AI); 2) measurements of multiple molecule biomarkers in vivo (in or on the body) or ex vivo (in samples collected from patients) including sensors built on a nanometer scale and microfluidic devices; 3) remote disease monitoring by implementation technologies complementary to the first 2 categories - smart wearable devices or at-home examination tools.

A best example for the first category is the Apple Watch that can gather dense personal data i.e. heart rate and blood oxygen level at numerous time points per day at both individual and population level. This is a very promising wearable technology that has the potential to move us even further to being able to closely monitor diabetes by measuring blood glucose levels with future iterations of the sensors, and even help identify undiagnosed diabetes. It can have extraordinary implications considering that diabetes is a major health problem in the western world including in the US where it is estimated that 30 million people have diabetes of whom 7.5 million or 25% remain undiagnosed and are unaware they have the disease. Further, about 84 million people have pre-diabetes, a condition with higher than normal blood glucose levels that puts individuals at high risk of developing diabetes. In oral medicine, in particular periodontal medicine, this has significant implications knowing that patients with chronic hyperglycemia are 2-3 times more likely to have periodontitis and its management can improve control blood glucose levels. Therefore, having access to tight monitoring of blood glucose levels recorded by wearable devices can significantly improve the management of periodontitis in a personalized manner and more broadly at population level. It is worth mentioning that roughly 50% of the US population has some degree of periodontitis, in many cases undiagnosed and/or not adequately managed.

An example of promising technologies in the second category are lab-on-a-chip (LOC) devices, miniaturized devices that integrate into a single chip multiple analyses like DNA sequencing or biochemical detection of multiple biomarkers. LOC has the ability to control cells at the single-cell level while dealing with a large number of them in seconds, for example using high-speed flow cytometry, a technology that we are using in the lab to sort and analyze individual cells in oral samples. Similarly, small footprint sequencing devices using nanopore technology have the potential to bring these complex and comprehensive analyses chair-side and thus eliminating the need to send samples to the lab and wait for hours or days for results. This may greatly impact the way we monitor disease at follow up appointments, for example at periodontal maintenance visits. We are testing such a system for chair-side sequencing in both targeted and non targeted ways to identify reliable disease activity biomarkers for periodontitis.

In the third category, technologies designed for oral disease diagnosis and monitoring, such nano-sensors and microfluidic chambers could be integrated in mouth guards or via tissue adhesive sleeves (Steigmann et al. Front. Pharmacol. 2020). This would allow for at home data collection that can be wirelessly transferred to smart devices and uploaded via HIPAA-compliant applications into a database accessible by health care providers and AI algorithms to flag those who should be seen in office. Further, machine learning (ML) applied within the smart device application would give live feedback to patients to better understand how well controlled they condition is and given suggestion on what should be modified in the at-home management. Similarly, camera-enabled tooth brushes could provide clues on oral conditions from the comfort of one’s home. At-home oral image capturing technologies are increasingly being implemented by orthodontists to monitor progress of tooth movement e.g. by using a ScanBox device that holds the patient’s phone and captures intra-oral photos.