Knowledge, Attitude and Practice of Periodontists and Postgraduate Students in Periodontics Towards Periodontal Vaccine: A Cross-Sectional Study

Introduction

Periodontal diseases are polymicrobial inflammatory diseases involving the interaction between pathogens and the host’s immune response in a susceptible host. The pathogenesis is initiated as a dysbiosis of the microflora through the accumulation of specific gram-negative bacteria such as Porphyromonas gingivalis, Tanerella forsythia and Treponema denticola. These pathogens have the capacity to stimulate the host’s immune response though their virulence factors. Thus, these components can serve as vaccine targets.

Vaccines have been successful in eliminating the prevalence of various debilitating diseases. However in periodontitis, due to the complexity of periodontopathic bacteria, the identification of specific antigens for the development of a vaccine is complicated.

Till today, there is no specific preventive procedure for periodontal diseases, and the treatment provided is palliative. Therefore the availability of periodontal vaccines could prevent and modulate periodontal disease, and can also enhance the quality of life of individuals for whom periodontal treatment cannot be easily obtained.

Active immunization using whole bacterial cells, outer components, or synthetic peptides as antigens and passive immunization with monoclonal antibodies against P. gingivalis have been carried out in numerous clinical trials which have gained positive results by potentiation of the humoral immune response, increased mucosal immunity, increased levels of IgA and IgG2, decreased levels of P. gingivalis and other species in the microflora present in subgingival niches by inhibition of invasion into tissues and colonization of the periodontal tissues, reduction in alveolar bone loss associated with decreased levels of prostaglandin E2 (PGE 2) in the gingival crevicular fluid (GCF).¹

Also, development of a multigenic vaccine that could be efficient in targeting all four primary bacterial species which have been incriminated in the progression of periodontitis may be more successful than a vaccine against a single genus.

Therefore, a combination of molecular biology, genetic, and immunopathologic strategies should be considered to recognize bacterial antigens of periodontopathogens and their capability as vaccine targets for the development of a multigenic vaccine for prevention of periodontitis and as an adjunct to existing periodontal treatment need to be assessed.

Materials and Methods

This was a cross-sectional survey conducted among one hundred subjects. Ethical clearance for the study was obtained from the Institutional review board of Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bangalore. The data was obtained using an online Google form. The questionnaire consisted of 15 questions of which five were related to knowledge, five were related to attitude, and five questions were regarding practice with three options “yes”, “no” and “not sure” provided for each question.

The questionnaire was designed to assess the participant’s knowledge, attitude, and practice regarding periodontal vaccines. The Google form questionnaire was distributed among periodontists and postgraduate students of periodontics in Bangalore city and the responses were collected.

Statistical analysis

Statistical Package for Social Sciences (SPSS) for Windows Version 22.0 (Released 2013. Armonk, NY: IBM Corp.,) was used to perform statistical analyses.

Descriptive analysis of the explanatory and outcome parameters was performed using mean and standard deviation for quantitative variables, frequency, and proportions for categorical variables.

Chi-square test was applied to differentiate the responses given by the periodontists and postgraduate students in periodontics to the questionnaire on periodontal vaccine The level of significance was set at P <0.05.

Results

A total of one hundred participants were included in the study out of which 67 were postgraduate students in periodontics and 33 were periodontists from Bangalore city (Table 1).

The comparison of responses to the knowledge, attitude, and practice-based questions among the study participants showed statistically significant results for all the questions (Table 2, 3, 4).

Knowledge regarding periodontal vaccine among periodontists and postgraduate students was evident, and there was no statistical significant difference on comparison between both (Table 4).

Concerning the attitude towards periodontal vaccines (Table 5), 71.6% of postgraduate students and 48.5% of periodontists deferred to completely rely on periodontal vaccines. About 57.6% of periodontists and 42.4% of postgraduates agreed that people of all age groups can receive periodontal vaccine. 48.5% of periodontists and 26.9% of postgraduate students agreed with the statement that periodontal vaccine can negatively affect patient's attitude towards dental treatment.

Regarding the practice of periodontal vaccines (Table 6), 78.8% of periodontists and 58.2% of postgraduates agreed that periodontal vaccines should be given in multiple doses.

However, on comparing the responses given by periodontists and postgraduate students of periodontics, periodontists were found to have better knowledge, positive attitude and practice regarding periodontal vaccines (Table 7).

The overall mean score of knowledge was 3.33 ± 1.32, attitude was 2.33 ± 1.18 and practice was 3.2±1.44. On comparison, the mean score of attitude between PGs & periodontists was statistically significant with P value being 0.006 and the differences in the mean score of knowledge and practice were non-significant with P value of 0.86 and 0.22, respectively (Table 7).

Discussion

The use of vaccines in medicine has been an effective public health intervention for prevention of various infectious diseases. Periodontal vaccines, which have been a subject for research from the 1970s, are a proposed preventive modality for periodontal disease based on its polymicrobial etiology.²

In the present survey, periodontists demonstrated better knowledge than postgraduate students regarding periodontal vaccines. Also, periodontists showed a better attitude towards vaccines compared to postgraduate students. The survey highlighted a positive perspective on the practice of vaccines by periodontists compared to postgraduates.

Around 84% participants of the study were aware of periodontal vaccines. About 78% of the participants agreed that Porphyromonas gingivalis, Treponema denticola, Tanerella forsythia, and Aggregatibacter actinomycetemcomitans are the prime target bacterial species for periodontal vaccines as stated by Ranjan Malhotra et al., (2011), T. Parthasaradhi et al., (2015) and Pearl Bhardwaj et al., (2019).^1,3,4

About 69% of the participants agreed that vaccines could help provide quality oral care to patients, which is in concurrence with the statement given by Rashmi S Pattanshetty et al., (2018).⁵

Around 83% of the participants opined that periodontal vaccines are expanding boundaries in the field of periodontics which agree with the findings of BV Karthikeyan et al., (2006). However, 64% of them stated that we cannot completely rely on periodontal vaccines.⁶

About 51.5% of periodontists and 50.7% of postgraduate students agreed with the statement that dental education requires advancement due to the implementation of the periodontal vaccine. Accordingly, Marilyn J Field et al., (1995) proposed that progress in periodontal health care and the invention of new interventions require dental educators to revise how and what the students are taught and to adjust how patient care is provided within the dental school.⁷

Around 71% of the participants accepted that periodontal vaccines can be taken in a dental setup. 75.8% of periodontists and 74.6% of postgraduate students have affirmed the statement that vaccines can have a positive impact on their profession which corresponds to the statement given by Meenakshi S et al., (2020). She quoted that a successful vaccine for periodontitis could provide health benefits far exceeding the prevention and modulation of periodontal diseases, enhancing the standards of lifestyle of people for whom the periodontal treatment cannot be rendered easily.⁸

Since the current treatment modalities aid only in arresting the disease progression, but does not cure the disease completely, nor prevent the recurrence, there is a need for more sophisticated therapeutic modalities like vaccines targeting putative periodontal pathogens.

Conclusion

Thus from the present study, a conclusion can be derived that periodontists and postgraduate students had good knowledge, attitude and practice towards periodontal vaccines. On comparison between the groups, periodontists demonstrated a significant positive attitude compared to postgraduates towards periodontal vaccine as a targeted remedy or as an adjunct to mechanical debridement.

Financial support and sponsorship

Nil

Conflicts of interest

Nil