ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title MyPerioPath test does not substitute for conventional risk factor analysis in the identification of at risk periodontal patients.
Clinical Question In a patient with unknown periodontal status how will the use of the MyPerioPath test to identify risk compare to conventional risk factor analysis?
Clinical Bottom Line There is a rationale linking bacterial count to periodontal status, but there is no definitive evidence that classifies salivary bacterial count as a periodontal risk factor. Studies have demonstrated that certain bacteria are found more commonly and in higher concentrations in patients with periodontitis compared patients with healthy periodontium. However, there is no study showing bacteria that are always present in disease or are absent in health. There is also no evidence showing the sensitivity or specificity of MyPerioPath test.
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) 21261620Saygun/2011150 patients with and without periodontitisCase Control Study
Key resultsP. gingivalis, T. forsythia and P. intermedia potentially identify the presence of periodontitis. The author reported” The diagnostic sensitivity for periodontitis was 89.19 for P. gingivalis and for T. forsythia and 86.49 for P. intermedia, with specificities ranging from 83.78 to 94.59.”
#2) 9706862Umeda/1998202 patientsClinical Trial
Key resultsThe author states that “For P. gingivalis, P. intermedia, and T. denticola, the kappa values were 0.59 or greater, indicating a good agreement between saliva and pocket samples. Based on these results, we conclude that saliva is equal to or better than pocket samples (from 4 deepest pockets) to detect periodontopathic organisms in the oral cavity.”
#3) 21134228Slots/2011NAReview article
Key resultsThe consensus viewpoint of the scientific community is that specific bacteria cause both periodontitis and dental caries.
Evidence Search 2 search stings ("Chronic Periodontitis/microbiology"[Mesh]) AND "Saliva/microbiology"[Mesh] ("Polymerase Chain Reaction"[Mesh]) AND (("Saliva/microbiology"[Mesh]) AND ("Periodontal Pocket/microbiology"[Mesh]))
Comments on
The Evidence
Validity: The Saygon article was well executed and had a large N to give statistically significant results. The Umeda article concluded that saliva was equal or superior to the periodontal pocket for detecting periodontal organisms. However, a possible source of bias is that only the four deepest pockets were tested. There could have been more information to compare if more pockets were tested. The review article by Slots was well written, but there is the possibility for writer bias based on what is chosen to be included. Perspective: There is no available research to adequately answer the PICO question. The evidence from the articles provides groundwork data to give rational why it may be possible in the future to reliably predict periodontal disease based on salvia tests. Perspective: The test has a rationale behind it, but what it tests has not been shown to be a valid test that predicts periodontitis. The MyPerioPath test can be used as one of a number of tools in identifying risk, but should not be mistakenly used to diagnosis periodontitis.
Applicability The biggest question with MyPerioPath is that there is whether bacterial type and concentration in saliva can accurately predict periodontal disease. There is evidence that the types of bacteria are risk indicators of disease, but no conclusive evidence has shown causation between current levels and future periodontitis. Test has a rationale behind it, but it what it tests has not been shown to be a valid test that predicts periodontitis. The MyPerioPath test can be used as one of a number of tools in identifying risk, but should not be mistakenly used to diagnosis periodontitis.
Specialty/Discipline (Periodontics)
Keywords Periodontitis, Saliva, Bacterial Load, Polymerase Chain Reaction
ID# 2541
Date of submission: 08/02/2013spacer
E-mail Hoedebecke@uthscsa.edu
Author Blake Hoedebecke
Co-author(s) Kennon Koenig
Co-author(s) e-mail koenigkl@livemail.uthscsa.edu
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
Basic Science Rationale
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