Pharmacogenomics in Oral Medicine: An Overview

Introduction

The treatment of various oral medicines in dentistry varies and depends upon various factors. A genetic factor is one of the factors which affects the treatment outcome of genetic diseases. Pharmacogenomics is a branch of science that deals with the application of genomics technology in health development by developing specific drugs. The genetic factor helps in improving the effectiveness and safety of drugs.

Pharmacogenomics influences the drug absorption of certain individuals according to the genetic constitution. Therefore, it helps in providing better treatment outcomes. It is applicable in dentistry as various advanced drugs for managing oral lesions, autoimmune diseases, chronic orofacial, temporomandibular joint disorders, and trigeminal neuralgia are treated with better outcomes. As personalized medicine has been found to work best, pharmacogenomics is a boon for oral medicine and dentistry.

What Is Pharmacogenomics?

Pharmacogenomics is a branch of science that studies specific drug responses to human genetic composition and inheritance. The term is derived from genetics and pharmacology; therefore, it deals with applying medicine and genomics to various diseases. It helps in increasing the efficacy and safety of various drugs. It helps determine various drug dosages according to the individual's genetic constitution. It consists of a targeted drug delivery system in a specific genetic constitution for better treatment outcomes.

How Does Pharmacogenomics Work?

In pharmacogenomics, genomic information is used to examine individual responses to the drugs. Whenever a gene variant is linked with any particular drug response in a patient the dosage of the drug or another drug can be selected based on the information. This works the same way as the scientists assess gene variants associated with any disease and check the response of the body to any drug.

Therefore while studying any drug response in an individual researchers primarily focus on two factors which include -

1. How much of a drug is needed to reach its target in the body (pharmacokinetics)?

2. How well the target cells respond to the administered drug (pharmacodynamics).

Pharmacokinetics -

Pharmacokinetics comprises four processes which include absorption, distribution, metabolism, and excretion, these are often written as ADME.

• Absorption means how the drug enters the bloodstream after taking the pill orally or via intravenous injection.

• Distribution means where the drug travels after absorption and how much of the drug reaches the actual target site.

• Metabolism means how the drug gets broken down in the body which can occur due to the action of enzymes in the stomach.

• Excretion is the last stage which explains how a drug leaves the body either through urine, bile, or exhalation.

Pharmacodynamics

This means the molecular action of a drug on the target site or cells which can be heart tissue or neurons. The target cells include a cell surface site (receptors), an ion channel, or an intracellular target (an enzyme or regulatory protein). For example, beta-blockers used in the treatment of hypertension target the beta-2 adrenergic receptor (cell surface receptor) in response to the drug.

What Are the Scope of Pharmacogenomics in Oral Medicine?

Following are the various scopes of pharmacogenomics in oral medicine:

• Early Screening - It helps in screening various oral diseases at an early stage as it consists of knowledge of people's genetic constitution. It helps the individual to make certain lifestyle changes at an early stage to prevent various oral diseases. It helps in reducing susceptibility to various diseases.

• Drug Dosage - It helps provide a better drug dosage system according to the individual's age, weight, and genetic constituents. It increases the efficacy and metabolism of the drug in the body.

• Periodontal Health - It helps develop preventive care for gingivitis and periodontitis in individuals according to their genetic constituents and susceptibility. In addition, it helps identify people at higher risk of periodontal disease.

• Dental Caries - Dental caries are one of the most prevalent oral diseases that affect most of the population worldwide. It is considered a major cause of tooth loss globally. Pharmacogenomics enables early detection of dental caries by identifying genes and helps ensure a better treatment plan.

• Oral Cancer - It is one of the most common oral health diseases seen among the population. Pharmacogenomics helps develop medicines according to the sensitivity of cancer cells. It has provided better treatment outcomes for oral cancer in combination with chemotherapy and radiotherapy.

• Orthodontics - It has shown much better results in orthodontics as genetic factors play a crucial role in orthodontic treatment. It helps base the treatment on the genomics of craniofacial growth and dentofacial abnormalities. It helps in the early identification of syndromic-associated cleft lip and cleft palate. It helps provide personalized orthodontic treatment to the individual developed by individual genomic evidence.

What Factors Can Affect the Drug Response?

Multiple factors can affect the drug response which includes -

1. Genetic Factors -

• Drug-metabolizing enzymes affecting drug metabolism.

• Therapeutic targets affecting drug efficacy.

• Adverse drug reactions cause drug toxicity.

2. Environmental Factors -

• Alcohol drinking.

• Chemicals.

• Combined drugs effect.

• Dietary substances.

3. Physiological Factors -

• Age.

• Sex.

• Pregnancy.

• Exercise.

• Disease state.

• Starvation.

What Are the Benefits of Pharmacogenomics?

The following are the various benefits of pharmacogenomics:

• It helps predict proper drug dosage.

• It helps identify responses to certain drug doses in the individual's body.

• It ensures better efficacy of drugs.

• It helps determine correct drug dosage strategies.

• It helps minimize the side effects of medicine on the body.

• It helps improve medication compliance.

• It helps in optimizing drug therapy in patients.

• It helps ensure better treatment outcomes.

• It helps improve the overall response to the treatment and increases the patient's survival rate.

What Are the Challenges to Pharmacogenomics?

Some challenges can occur in the development and practical use of pharmacogenomics which include -

• Expensive mainly if insurance does not cover the cost.

• Access to certain tests may be limited.

Conclusion

The oral cavity is a portal that reflects an individual's overall health. Various kinds of health information can be derived from oral fluids. Recent advances in pharmacy and medicine branch of science have enabled the health sector to ensure good oral health and prevent various oral diseases. Vast opportunities for the development of oral health have emerged from the development of molecular dentistry, proteomes, transcriptomes, and human genome project. Pharmacogenomics is a recently developed branch of science that helps design and fabricate various diagnostic technologies, biomaterials, and therapeutics. It helps in ensuring better health and treatment plans. It can be used in dentistry for better treatment outcomes such as orthodontics tooth movement regulation and formation of periodontal ligaments. Therefore, it should be applied for better treatment outcomes.