‘Who cares about teeth?’
By Jessica Binkley
Although Georgios A. Kotsakis, DDS, MS, associate professor in the Department of Periodontics and a periodontist with UT Dentistry, has had an interest in making big-picture impacts to health care throughout his career, 2022 was a particularly fulfilling year for him.
With several awards from top organizations in the field, a publication of findings from a global study and three major multimillion-dollar National Institutes of Health grants under his belt, Kotsakis, who is also a doctoral candidate in cellular physiology, has made significant moves in overcoming what he considers one of oral health’s biggest challenges: periodontitis.
“Sometimes the impact that dental diseases have on human conditions goes unnoticed or is understated,” he said. “When talking about disease burden on a global level, with conditions such as heart disease and diabetes, there are many who say, ‘Who cares about teeth?’ But if you look at the data, consistently periodontitis, or severe gum disease, is one of the most prevalent diseases affecting quality of life.”
The global burden of gum disease
In 2019, Kotsakis took part in the Global Burden of Diseases project, co-leading a group of experts focused on aging and age-related diseases across the globe. The study, published in March 2022 in the British Medical Journal, was funded by the Bill and Melinda Gates Foundation and the National Institute on Aging through a grant awarded to Kotsakis.
The team included nearly 400 epidemiologists who provided global and country-specific estimates for more than 200 countries on life expectancy and the main causes of disability in older adults worldwide.
“I was very privileged to be one of the few dental researchers to be part of this dream team of epidemiologists,” Kotsakis said, noting that initially oral health was not considered in the global project. However, the issues caused by periodontitis for aging individuals — loss of teeth and jawbone destruction leading to eating and nutrition complications, as well as inflammation that can increase risk for diabetes, cardiovascular disease and other inflammatory illnesses — were too prevalent to ignore.
“The medical community realized that periodontitis is consistently one of the top 10 most prevalent noncommunicable diseases globally,” Kotsakis said. Noncommunicable diseases refer to chronic conditions that are not passed from person to person.
“A big part of my work in this project has been highlighting that periodontitis has traits of a noncommunicable disease, and it can and should be included in the prevention efforts of noncommunicable diseases that are inflammatory in nature, like diabetes or cardiovascular diseases.”
Shining a spotlight on periodontal diseases on the global stage is crucial, as funding is often much more limited for oral diseases compared to other medical conditions, he said.
“As oral health professionals and educators, we need to elevate the role, position and perceived impact of dentistry within the medical community if we’re going to tackle this health issue.”
Kotsakis also aims to tackle another pressing health issue — antibiotic resistance and the rise of superbugs.
Responsible use of antibiotics
In spring 2022, Kotsakis was awarded a $2.4 million grant from the National Institutes of Health to conduct a clinical trial studying the responsible use of antibiotics in combination with other treatments for periodontal disease.
Over-prescription and misuse of antibiotics lead to multi-resistant bacteria that kill tens of thousands of Americans every year due to antibiotic resistance, and there is a critical need to determine which specific patient populations benefit from antibiotics and to reduce antibiotic misuse.
Due to the prevalence of infections, dentistry is one of the top prescribers of antibiotics in health care. Because periodontitis is caused by oral bacteria in the plaque around teeth, systemic antibiotics often are used by dentists in conjunction with deep cleaning of the teeth to achieve treatment.
“But there is currently no good evidence on when it’s helpful to use antibiotics for periodontal disease,” Kotsakis said. “And with 40% of the U.S. population suffering from periodontal disease, it’s a real issue. Any dentist a patient sees has their own opinion about whether an antibiotic is needed or not, and we don’t know if it actually provides a benefit or for which patients, specifically, it will benefit.”
In collaboration with the American Dental Association Science and Research Institute, the study, one of the largest to ever be performed in dentistry, will enroll more than 1,000 periodontal patients from across the country to generate real-world data on periodontal disease treatments supplemented by the use of antibiotics.
“We’ll assess whether antibiotics really have an effect and determine specific patient factors, like age and sex, to be able to predict who requires antibiotics and who doesn’t,” Kotsakis said. “The goal of this clinical trial is to shape antibiotic usage guidelines that will be taught in dental schools to better educate our dentists and help the community.”
The power of teamwork
Kotsakis attributes his success to the power of teamwork and having a strong support system.
“It takes a village. You have to be driven and persistent, and you have to have other driven people around you who understand your commitments and sacrifice. It makes a big impact to be surrounded by a team of passionate, dedicated people, both in the lab and, in my case, I’m lucky to have that support at home as well,” Kotsakis said, referring to his wife, Vanessa Chrepa, DDS, MS, who is an associate professor in the Department of Endodontics and a practicing endodontist with UT Dentistry.
For Kotsakis, the joy of discovery and the opportunity to create a healthier world drive his research ambitions.
“As a clinician, I get immense gratification from treating one patient, but I only have two hands and eight hours a day, so I can only help a finite amount of people. But that impact you can have on public health and global health through research, through finding better ways to treat our patients, that’s tremendous.”