Sivaraman Prakasam, B.D.S., M.S.D., Ph.D., is an assistant professor in the Department of Periodontology, OHSU School of Dentistry. In addition to his research program, Prakasam is a clinical educator and a practicing clinician, limiting his practice to periodontics and dental implant placement.
Prakasam and family
Where are you from originally?
I was born and raised in India. I got my dental degree there – a B.D.S. as it’s known in India – and as soon as I was done with that, I knew I wanted to pursue research. I went to the Stony Brook University in New York for my Ph.D. and was fortunate to work under the mentorship of Dr. Chris Cutler an innate immunologist and periodontist. This helped shape the direction of my research career. Though I knew I wanted to do research, I found I missed the clinical side of things while I was completing my Ph.D., so I decided to go back and pursue advanced clinical training. I went to Indiana University School of Dentistry and did my periodontal residency for my specialty training. I stayed as a clinical faculty member for another four years. This was sort of an unofficial postdoc. Because of the projects I developed there, I was then able to apply for a position here at OHSU, which is also part research, part clinical. Though there are similarities, I find I have access to a lot more resources here.
What’s the focus of your research?
Understanding periodontal disease. The pervading thought on what this disease is that the biofilm or tooth plaque is the primary etiology and that some people are more susceptible to developing a response to it. Also, there are certain bacteria that are commonly associated with disease process. So, one of the things I worked on as a clinical professor at Indiana was salivary diagnostics. I was able to incorporate the focus of my Ph.D. work – innate immunology – but in terms of translational research. The goal was to try and identify salivary markers that we see in periodontal disease. In developing that project, I came across something called Peptidoglycan recognition proteins, a group of innate immune receptors. It’s unique in the sense it’s a secreted receptor that does two things: kill bacteria and modulate inflammation. Up to now, I’ve been studying this receptor mostly in mice models. But my goal is to understand the relevance of this molecule in terms of human diseases, particularly inflammatory diseases like gum disease. In addition to figuring out what role the receptor plays in periodontal disease, I want to see if it can be used as a biomarker for identifying disease.
Another avenue I’m exploring is that this receptor may have a role to play in other systemic diseases. One of the emerging concepts is that oral disease may be a risk factor or causative agent for distant diseases such as cardiovascular disease and diabetes. There are varied hypotheses about the connection between oral health and say, cardiovascular disease. The controversy lies in causality. Are these people who have poor gum health alongside cardiovascular disease, generally prone to reduced immunity or hyper inflammation? Or is it the type or amount of oral bacteria itself that’s the cause?
The cause may, in fact, be direct. There is a large build-up of bacteria when people don’t brush regularly so that when they do brush or have dental work done like a tooth extraction, this can cause the abnormal levels of bacteria to enter the circulation system, which can eventually precipitate changes in the cardiovascular system. Studies have identified traces of these bacteria in atherosclerotic plaque. These are dead oral bacteria that are not supposed to be in the heart but are often found in people who die of cardiovascular disease. These bacteria have also been found in dead fetuses in certain cases of pregnancy that don’t go to term. So, investigators are trying to establish the connection, and one of my goals is to find out if this receptor could be the link. There is some proteomic data that suggest this molecule may be relevant in various systemic inflammatory diseases.
So this is my primary focus of my research, but I also do a lot of small projects. One of them is my work with a collaborator in Iowa – we do a lot of data mining of a health insurance data base, trying to find links between oral diseases and systemic diseases. We’ve published a few papers published from this line of research. I’m also interested in safety. When I was in Indiana, inspired by Atul Gawande’s pioneering work on WHO Surgical Safety checklist, we developed a safety checklist for implant placement, and that’s been published. Though this is not my main research focus, I feel it’s very important work. Most states have very lax laws in terms of who gets to perform what types of procedures. In the case of dental implant placement, a dentist who has taken minimal training (two to three weeks) may be allowed do the same procedure as someone who’s had two or three years’ worth of training. Developing safety protocols is one way to protect the patient and guide inexperienced practitioners.
What do you do when you’re not at work?
I read a lot of books, mostly non-fiction, about self-improvement, leadership, and communication. But mostly I spend time with my family. My wife is at home now with our son who’s two and a half, and she’s also an aspiring pastry chef. Trying not to eat pastries keeps me plenty busy!