Dr Yinghong Zhou explains why prevention matters for young Australians, what periodontitis does beneath the gums, and how immune-instructive biomaterials may change periodontal repair.
Delayed dental care. Social media-influenced cosmetic treatments. Wisdom teeth problems. Preventable sports injuries. When it comes to oral health, young Australians are at risk of falling through the cracks. An Australian Dental Association (ADA) consumer survey of more than 25,000 people, released for Dental Health Week, reveals the extent of the problems facing 18–25-year-olds.
As much as 60% of respondents said social media had influenced decisions about cosmetic dental procedures and only 38% who play contact or high impact sports were wearing a mouthguard, despite the high risk of dental trauma. Cost pressures, busy lives and reduced support were cited as reasons why young adults may delay dental care.
Commenting on the study is Yinghong Zhou, Senior Lecturer and Discipline Lead in Oral Biosciences at the School of Dentistry at The University of Queensland. Her work spans periodontology, osteoimmunology and biomedical engineering, with a focus on using biomaterials and bioactive signals to control damaging inflammation and regenerate tooth-supporting tissues.
Early adulthood is the time to establish positive oral health habits
Dr Zhou says that early adulthood is an opportune time to form oral care habits that can benefit a lifetime.
“The 18-25 year old age group is often managing health independently for the first time. Moving out of home, studying or starting work, budgeting and sometimes coming off their parents’ private health insurance.”
Sports drinks: sugar and acid in the same bottle
Establishing good oral health habits is important in early adulthood, but this also means understanding how everyday choices can affect oral health.
Dr Zhou says sports drinks are one example where young people may not be fully aware of the risks to their teeth.
“There are concerning trends regarding children and adolescents choosing sports drinks instead of water, to quench their thirst. Many may not realise just how high the sugar levels can be… as well as how sports drinks can cause tooth decay and tooth erosion.”
“ADA figures show that a 600mL sport drink contains, on average, about 34 grams, or 8.5 teaspoons of added sugar. Sugar increases the risk of tooth decay, while acids in these drinks can soften and gradually wear away enamel.”
“Sugar free does not necessarily mean tooth-friendly, because the drink may still be acidic.”
Dr Zhou encourages young Australians to choose water as their main drink for hydration.
“For most short or lower-intensity exercise, water is the safest choice for teeth and usually all that is need for hydration,” she explains.
“Sports drinks are primarily designed for prolonged, high-intensity activity. If you do use one, drink it rather than sipping for a long period. Do not swish it around the mouth.”
Shedding light on habits that build a lifetime of good oral health
Dr Zhou says that poor oral hygiene can allow dental plaque and harmful bacteria to accumulate around the teeth and gums, increasing the risk of gum inflammation and, if left untreated, more serious gum disease.
“If plaque is not removed effectively through regular brushing, cleaning between the teeth and professional dental care when needed, bacteria can build up around the gums and trigger inflammation. In some people, persistent inflammation can progress to periodontitis, where the tissues and bone supporting the teeth begin to break down.”
“Bacteria trigger inflammatory immune cells, which in turn drive bone-dissolving activity, creating literal empty space where bone used to be. As that support disappears, teeth start to loosen and eventually fall out if action is not taken.”
Dr Zhou says people might simply experience bleeding gums which can generally be easily corrected with professional cleaning and by applying the correct flossing and brushing techniques.
“Bleeding gums are an early warning sign, and not something to ignore. Other signs can include red or swollen gums, persistent bad breath, gum recession, sensitivity, a change in the spaces between teeth, pain when chewing or teeth becoming loose. It’s only when people neglect the first sign, that it may eventually lead to the severe form of gum disease,” Zhou explains.
“Regular dental check-ups and professional cleaning can help young people identify problems early and avoid significant issues.”
The costs of gum disease can remain hidden for years: Zhou
“The problem with gum disease is that its ‘cost’ can be invisible for some time – a case of ‘out of sight, out of mind,” she says.
“By the time teeth feel loose, substantial support may already have been lost. Treatment can control periodontitis and help people keep their teeth, but preventing damage is far simpler than trying to rebuild complex tissues. Periodontitis can progress with little or no pain, so a professional examination can make a big difference.”

Latest figures on periodontitis
The latest Australian clinical survey found moderate or severe periodontitis in 8.6% of people aged 15-24, rising with age to 59% among those aged 65 and over. Across all adults aged 15 and over, prevalence increased from about 23% in 2004-06 to 30% in 2017-18.
“Periodontitis is a chromic, multifactorial inflammatory disease associated with an imbalance of the community of bacteria that naturally live in dental plaque. Bacteria initiate the problem, but much of the tissue destruction occurs through an immune response that fails to resolve appropriately.”
“It is not simply a case of ‘bad bacteria eating the bone’. The bacterial biofilm triggers inflammatory signals and, in a susceptible person, that immune response can become unbalanced. This activates cells that ‘resorb’, or breakdown the alveolar bone –the part of the jaw that supports the teeth. As bone and connective tissues supporting the teeth are lost, periodontal pockets can deepen, gums may recede, and teeth can eventually loosen.”
Exploring tissue damage, immune response and repair materials
Dr Zhou’s interest in the periodontal health began while completing her dental degree overseas. She later completed a PhD in biomedical engineering, bringing biological and engineering perspectives together to explore how periodontal tissues are damaged, how the immune system shapes healing, and how biomaterials can be designed to control inflammation and promote tissue repair.
“Periodontitis ‘sits’ at a hugely fascinating interface; microbiology, immunology, bone biology and engineering all meet at a very small space around the tooth. I was drawn to the question of whether we could do more than remove the cause, and whether we could actively guide the local immune environment back towards inflammation resolution and tissue regeneration.”
“Periodontitis starts as a bacterial infection. In normal circumstances, the immune system clears microbial threats (and then resolves once the threat is controlled) with periodontitis, that immune response becomes dysregulated. Instead of returning to a healthy balance, ongoing inflammation starts damaging the tissues that support the teeth (both the soft gum tissue and the hard bone underneath).”
Why rebuilding the tissues around a tooth is so challenging
“This damage left by periodontitis is not a smooth, simple hole. Defects can extend around one or more sides of a tooth root, vary in depth and width, and sit within a constantly loaded, bacteria-rich environment. More importantly, the periodontium is a complex, multi-tissue attachment system: alveolar bone, periodontal ligament, root cementum and gingiva must heal in the right places and in the right relationship.”
Filling a space with bone-like material is not the same as restoring a functioning periodontium. True regeneration requires new bone, new cementum on the root, and correctly oriented periodontal ligament fibres connecting the two.
“The irregular shape of these defects makes it harder to stabilise the wound, maintain space, establish a blood supply and co-ordinate the regeneration of these different tissues.”
“The lingering inflammation actively suppresses the body’s own regenerative potential. So the longer it goes untreated, the harder it is to rectify.”
Closer integration of dental
“The mouth is not isolated from the rest of the body. Periodontitis is associated with conditions including diabetes and cardiovascular disease, with shared risk factors and systemic inflammation contributing to the relationship. Association doesn’t mean that every case of periodontitis directly causes another disease, but the growing evidence linking oral and general health reinforces the importance of recognising oral health as part of overall health – and of closer integration between dental and general healthcare.”
Turning a scaffold into an active healing partner

Current periodontal regenerative treatments use bone grafting materials, barrier membranes and other approaches to help stabilise the wound, maintain space and provide an environment in which new tissue can form. However, reliably rebuilding the complex tissues lost through periodontitis remains challenging.
This is where Dr Zhou sees an opportunity for the next generation of regenerative biomaterials. Her research explores ‘immune-instructive’ materials designed not only to fill or support a periodontal defect, but also to interact with the local immune environment and help create conditions that favors healing.
“A scaffold can be thought of as temporary architecture. What we are exploring is how to make that architecture more biologically active. It could deliver carefully selected signals, such as bioactive molecules, therapeutic ions or cell-derived factors, that help regulate inflammation, encourage blood vessel formation and support the cells responsible for rebuilding bone and the periodontal ligament.”
“Ideally, the scaffold would conform to the irregular shape of the defect and act locally… the goal is not to switch the immune system off. Inflammation is essential for defence and early healing. The goal is to restore balance – to move from a persistent, destructive response, towards one that resolves inflammation and supports repair.
She says these approaches remain an emerging area of research rather than a replacement for established periodontal care.
“The exciting possibility is that, in the future, treatment may be tailored not only to the shape of a defect, but also to the biological and immune needs of the individual patient.”
Prevention is still key: Zhou
Dr Zhou says that while the future of regenerative dentistry taking place inside the lab is exciting, the best ‘technology’ is still prevention.
“If your gums bleed, if a wisdom tooth is repeatedly sore, or if you have been putting off a checkup, act while the problem is small. The habits established in early adulthood can protect your smile for decades.”
This article was produced by AIPS’s Ella Legg with Dr Yinghong Zhou







