ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Salivary Diagnostics Use in Patients at Risk of Periodontal Disease Progression
Clinical Question In patients with periodontal disease, does the use of oral DNA salivary testing increase the accuracy in diagnosing a patient’s risk of periodontal disease better than using radiographic examination and clinical probing alone?
Clinical Bottom Line DNA salivary testing may increase the accuracy and ease of diagnosis in patients with high risk of periodontal disease. For patients with the disease and those with significant risk, supplementing a traditional clinical exam with salivary testing may enhance detection of periodontal disease before effects of the disease process are manifested and clinical detection is possible.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19254128Ramseier/200950 healthy/gingivitis patients, 50 with periodontitisClinical Trial
Key resultsSalivary diagnostic data was highly accurate in assessing periodontal disease in patients with multiple combinations of salivary biomarkers associated with periodontitis. These biomarkers included significantly elevated levels of matrix metalloproteinase 8 and 9, osteoprotegerin, and red-complex anaerobic periodontal pathogens (specifically Porphyromonas gingivalis and Treponema denticola). Patients with “elevated salivary MMP-8 and T. denticola biofilm levels” showed strong “combinational characteristics in predicting periodontal disease severity,” with an odds ratio of 24.6 and 95% confidence interval of 5.2 to 116.5 (Ramseier et al. 2009). These findings, combined with the use of other biomarkers in future developments, have significant diagnostic potential.
#2) 23024320Giannobile/2012Review of articles published in peer-reviewed journalsReview
Key resultsPrevious studies have correlated certain biomarkers to aid in the prediction of disease, including matrix metalloproteinase-8, microbial factors, and pro-inflammatory cytokine IL-1β (Miller et al. 2006; Costa et al. 2010; Gursoy et al. 2010; Heikkinen et al. 2010). The advent of rapid detection of these biomarkers with microfluidic tests has significantly increased access to these diagnostic tools in the clinical setting (Giannobile 2012). Salivary testing shows promise, but the validity of these tests needs to be determined over time before widespread diagnoses and risk assessments are based on these tests (Giannobile 2009).
#3) 17199543Boutaga/200721 adults with periodontitisComparative Study
Key resultsHistorically, microbe sampling in saliva has been a poor representation of the oral flora. Real-time PCR has significantly enhanced the speed in detection of microorganisms in the oral cavity contributing to its practical use chairside. This study found the sensitivity of salivary sampling with real-time PCR to be 100% for detection of the following common periodontal pathogens: AA, P. gingivalis, T. forsythensis, and M. micros (excluding P. intermedia at 93.8%). Mouthwash samples may provide a practical and reliable diagnostic tool in patients with periodontitis, and may also be used in monitoring the patient’s microbial activity throughout periodontal treatment.
Evidence Search Search “Salivary Diagnostics” [MeSH], “Periodontitis” [MeSH]
Comments on
The Evidence
Validity: The Ramseier article shows good potential for salivary DNA testing, and the biomarkers used in methods for detection of incipient disease or diagnostic predictability provide a foundation from which to design future studies for stronger evidence. The review article by Giannobile discusses potential and direction for this type of diagnostic testing with a good foundation as to why the topic is important. However, it is only a review article, and clinical diagnostic decisions should not be heavily based upon its recommendations. The Boutaga article evaluated the effectiveness of real-time PCR use with mouthwash samples as a viable method of microbial detection in disease patients only. Real-time PCR would be a valuable component to salivary diagnostics as a reliable way to indicate the presence of periodontal pathogens. Perspective: It seems that salivary testing is only just emerging as a viable diagnostic tool. It could be valuable in a select few patients with elevated risk within a narrow window of time when used with alveolar bone height and clinical attachment loss measurements. However, the diagnostic benefit at this time may be premature for widespread use.
Applicability Use of salivary testing could reduce the time and discomfort associated with periodontal probing, and may increase the accuracy in detection of risk and or severity of periodontal disease. Chairside diagnostic testing could prove to assist in subclinical detection of incipient periodontal disease and reduce the chance of progression to anatomical loss of tooth support. This type of testing should not be used in place of traditional radiographic and clinical exam, but as an additional diagnostic tool in those with an increased risk of developing periodontitis or patients susceptible to lose stability in their periodontal status. Salivary testing is within the capability of the general dental practice and adds minimal cost and discomfort to the patient for the benefit, but is currently in a stage of infancy and may only be truly effective within a narrow diagnostic time frame in its current state.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords Saliva, salivary protein, periodontitis, Diagnosis, Mouthwash, Periodontal disease
ID# 2520
Date of submission: 08/02/2013spacer
E-mail walkercj@uthscsa.edu
Author Christopher Walker
Co-author(s) Vincent Ho
Co-author(s) e-mail vincentlieuho@gmail.com
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
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