Title Salivary Biomarker Testing Can Be Useful Together with Assessment of Clinical and Radiographic Parameters in the Diagnosis of Chronic Periodontitis in Adults
Clinical Question How does salivary biomarker testing compare to clinical and radiographic parameters in the diagnosis of Chronic Periodontitis in adults?
Clinical Bottom Line Salivary biomarker testing can be useful together with assessment of clinical and radiographic parameters in the diagnosis of Chronic Periodontitis in adults. A recent study shows specific salivary biomarkers to have high sensitivity, specificity and PPV, together with threshold values that differentiate health from disease. However, due to lack of clinical evidence as a diagnostic tool alone, clinical evaluation should continue to be used for periodontal disease diagnosis. Salivary biomarker testing would have value in patient risk assessment, particularly in the early stages of disease onset.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
22926406Ebersole/201230 healthy patients and 50 chronic periodontitis patients underwent salivary sampling for biomarkers associated with inflammation and tissue destructionProspective Cohort
Key resultsEbersole et al. concluded that certain salivary biomarkers have high sensitivity, specificity and positive predictive value in discriminating disease from health in chronic periodontitis. Biomarkers compared in health and disease included IL-1B, IL-6, MMP-8 and IFN-a. Sensitivity ranged from 80-88% for Interleukin-1B, IL-6 and Matrix metalloproteinase-8, and 54% for Interferon-a. The specificity of IL-1B, IL-6, MMP-8 and INF-a was 93%, 97%, 87% and 100%, respectively. PPV ranged from 91-100%. NPV ranged from 72-82%, and 57% for INF-a. Pairings of IL-1B, IL-6 and MMP-8 yielded sensitivity and specificity ranging at or above 94%.
Evidence Search (Saliva AND periodontitis AND “last 5 years” [PDat) AND Humans [MeSH])
Comments on
The Evidence
The gold standard was based on acceptable clinical parameters used to diagnose periodontitis with an adequate spectrum of disease activity, and used on all patients. There were no competing interests. Salivary biomarkers measured in this study included IL-1B, IL-6, MMP-8 and INF-a based on previously established associations with inflammation and tissue destruction. The sensitivity, specificity, PPV, NPV of each, and receiver operating characteristic (ROC) curves were used compare these biomarkers in periodontitis and in health. Also, these values were significantly different between the 2 groups irrespective of the “normal” variation that occurs in biomarker levels within-subject. Threshold values for specific salivary analytes and pairings were obtained from this study that clearly discriminate health from disease. Limitations of this study include the study design, non-randomization, sample size, differences in demographics and health characteristics between the 2 groups, exclusion of co-morbid conditions, and absence of repeated measures for the periodontitis group that was conducted in the health group.
Applicability Salivary biomarker testing may be of benefit as a diagnostic aid or risk assessment tool for periodontal disease, particularly in the early stages of chronic periodontitis where clinical parameters may not clearly differentiate between health and disease. However, limitations exist depending on the health status of the patient and determining the type and extent of disease. Due to a lack of clinical evidence at this time, salivary testing should be used only in conjunction with clinical examination in the diagnosis of periodontal disease.
Specialty (Public Health) (General Dentistry) (Periodontics) (Restorative Dentistry) (Dental Hygiene)
Keywords Salivary Biomarker testing, diagnosis of periodontal disease.
ID# 2522
Date of submission 07/31/2013
E-mail mahendraraja@livemail.uthscsa.edu
Author Sathya Mahendrarajah
Co-author(s) James Moore
Co-author(s) e-mail richard22658@yahhoo.com
Faculty mentor
Faculty mentor e-mail
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available