Nano-bio enabled diagnostic devices for oral healthcare

牙周病（牙龈疾病）是一个主要的医疗保健问题，它影响牙齿周围和支撑牙齿的组织（牙周组织）。患有牙周病的患者遭受牙龈炎症和出血，并且由于炎症导致的破坏性酶激活，还具有牙龈萎缩和底层骨（其形成牙槽）的损失。牙齿松动，牙齿功能受损。事实上，这种情况往往会导致牙齿脱落。2009年的成人牙齿健康调查显示，英国55岁以上的人口中约有15%患有严重的牙周病。此外，与1998年的调查结果相比，英国现在有更多的人受到牙周病的影响，人们在生命的早期患上更严重的疾病。此外，吸烟者患严重牙周病的风险大大增加，肥胖和糖尿病患者也是如此。因此，老龄化人口的不良饮食和生活方式的选择带来了越来越多的口腔保健负担。在经济方面，牙周病是耗时和昂贵的治疗和牙周病的整体成本，英国经济估计为£ 27.8亿在2008年。牙科传统上是一个外科学科，侧重于诊断和修复，但现在已经接受了监测和预防的原则。因此，该项目的总体目标是开发一种设备，最终使患者和牙医能够经济，准确和简单地诊断和监测牙周病。一项由科技策略委员会资助的试验计划，成功地将微电子技术与生物科技结合，制造出一种小型传感器（即“纳米生物传感器”），可以测量导致牙周病组织破坏的酶的活性。我们现正评估这种传感器对口腔健康，特别是牙周病的价值。我们将使用患者可接受的唾液采样，因为收集简单，非侵入性，并且涉及最小的不适。我们将进行一项临床试验，在该试验中，我们将监测不同严重程度的牙周病患者，并在整个治疗过程中收集唾液样本，以便使用该设备进行分析。在这项试验中，我们将检查疾病的进展和治疗的效果，以模拟相关的临床情况。此外，我们会将仪器的效能与较成熟的实验室化验方法作比较，这些仪器可及早评估疾病风险，从而有助预防严重疾病的发展，并促进疾病管理，例如界定疾病活动的变化及评估治疗效果。对于临床医生来说，该设备将提供对潜在生物过程的即时和直接测量，这将以成本有效和节省成本的方式加速临床决策。对于患者来说，由于唾液采样不需要特殊技能，并且该设备使用简单，因此可以进行自我监测;这将提高患者的意识，鼓励调整口腔保健，并为医疗保健决策提供信息。纳米生物传感器体积小，便于携带，因此不仅可以在家庭中使用，还可以在没有医疗保健设施的社区中使用;在这方面，这些设备可以有助于流行病学研究和个人医疗保健。除了牙周病，口腔癌，干燥病和种植体周围炎（对牙科种植体的不良炎症反应）是口腔保健问题，可以通过唾液分析进行监测。越来越多的人认为唾液是一种有用的诊断液体，用于诊断一系列系统性疾病，如心血管疾病和糖尿病。在实验室中，这些设备可以直接提供即时的分析数据，改进传统的复杂协议。

Periodontal disease (gum disease) is a major healthcare problem which affects the tissues that surround and support the teeth (the periodontium). Patients with periodontal disease suffer gum inflammation and bleeding and also have receding gums and loss of the underlying bone (which forms the tooth socket) as the result of damaging enzymes activated as the result of inflammation. Teeth become loose and tooth function is compromised. Indeed, this condition often leads to tooth loss. The Adult Dental Health survey of 2009 revealed some 15% of the UK population aged over 55 have severe periodontal disease. Furthermore, in comparison to the findings of the 1998 survey, more people in the UK are now affected by periodontal disease and people are developing more severe disease earlier in life. In addition, smokers have a greatly increased risk of developing severe periodontal disease as do individuals with obesity and diabetes. Thus, an ageing population making poor diet and lifestyle choices presents an increasing oral healthcare burden. In economic terms, periodontal disease is time-consuming and expensive to treat and the holistic cost of periodontal disease to the UK economy was estimated as £2.78 billion in 2008.Dentistry is traditionally a surgical discipline focussing on diagnosis and repair but has now embraced the principles of monitoring and prevention. The overall aim of this project, therefore, is to develop a device that will ultimately enable patients and dentists to diagnose and monitor periodontal disease economically, accurately and simply. A successful pilot project, also funded by the Technology Strategy Board, has shown that technology which combines microelectronics and biotechnology to produce a small sensor (a 'nano-bio sensor') can measure the activity of enzymes which cause tissue destruction in periodontal disease.We now aim to assess the value of the sensor to oral healthcare, and in particular periodontal disease. We will use saliva sampling which is acceptable to patients because collection is simple, non-invasive and involves minimal discomfort. We will conduct a clinical trial in which we will monitor patients with periodontal disease of varying degrees of severity and collect saliva samples throughout their treatment for analysis using the device. In this trialwe will examine progression of disease and the effects of treatment to model relevant clinical scenarios. Furthermore, we will compare the device's performance against more established laboratory assays.These devices will allow for much earlier assessment of disease risk, thereby helping to prevent development of severe disease and to facilitate disease management for example by defining changes in disease activity and assessing the effects of treatment. For the clinician this device will provide an immediate and direct measure of the underlying biological processes which will accelerate clinical decision making in a cost effective and cost saving manner. For the patient, selfmonitoring will be possible as saliva sampling requires no special skills and the device is simple to use; this will increase patient awareness, encourage adjustment in oral healthcare and inform healthcare decisions. The nano-bio sensor is small and portable and therefore can be employed not only in the home but also in communities not served by healthcare facilities; in this regard these devices could contribute to epidemiological studies as well as individual healthcare. Beyond periodontal disease, oral cancer, Sjogren's disease and peri-implantitis (an undesirable inflammatory response todental implants) are oral healthcare problems which can be monitored by salivary analysis. Increasingly, saliva is seen as a useful diagnostic fluid for a range of systemic disorders such as cardiovascular disease and diabetes. In the laboratory these devices could straightforwardly provide immediate analytical data improving on traditional, complicated protocols.