Saliva as a diagnostic tool for periodontal disease: current state and future directions

To evaluate the effect of oral zinc supplementation on salivary MMP-8 levels in periodontitis: A randomized, double-blind, placebo-controlled study

Background and objective

Zinc is an essential micronutrient that plays a crucial role in maintaining oral health. Periodontitis is a widespread oral disease characterized by inflammation and destruction of the gums and surrounding tissues. The objective of this study was to evaluate the effect of oral zinc supplementation as an adjunct to scaling and root planing in the treatment of periodontitis by evaluating its effects on clinical parameters and salivary MMP-8 level.

Methods

42 patients were enrolled in the study from the periodontology OPD of a tertiary care hospital in India. The subjects were divided into two groups: group 1 and group 2 consisting of 21 patients each of moderate to severe periodontitis. Group 1 was given oral zinc supplementation along with scaling and root planing (SRP) and group 2 was given placebo tablet along with SRP for 1 month. Several periodontal parameters were assessed, including Papillary bleeding Index (BI), Gingival index (GI), Probing pocket depth (PPD) and Clinical attachment level (CAL) at baseline as well as at 1 month post treatment. Around 3 ml of whole unstimulated saliva was collected for MMP-8 estimation by ELISA method at baseline as well as at 1 month.

Results

The data was analyzed using SPSS version 26. All clinical parameters and MMP-8 level in saliva were comparable at baseline. 1 month after respective treatment modalities were performed in each group, it was found that all clinical parameters and salivary MMP-8 level showed significant differences with group 1 (zinc + SRP) showing highly significant decrease in GI, PPD and CAL (p < 0.01) and significant decrease in BI and salivary MMP-8 level when compared to group 2 (placebo + SRP) (p < 0.05).

Conclusion

When compared with scaling and root planing alone, the administration of oral zinc supplementation along with scaling and root planing showed greater reduction in clinical parameters and salivary MMP-8 levels in patients with moderate to severe periodontitis. Zinc has a positive effect in management of periodontitis and can serve as an easy, cost effective, harmless and beneficial adjunct in treatment of periodontitis.

Evaluation of the Faecal Occult Blood Test as a Screening Tool for Periodontal Disease: A Case-Control Study

OBJECTIVES

To assess the feasibility of using a faecal occult blood test (FOBT) kit as a screening tool for periodontal disease. Additionally, the study aimed to evaluate the test's sensitivity and specificity while exploring the influence of factors like age, sex and the number of teeth on its performance.

METHODS

A prospective observational case-control study involving 150 participants divided into three groups on the basis of the basic periodontal examination index: healthy (n = 21), gingivitis (n = 52) and periodontitis (n = 77). Salivary occult blood tests were conducted using the Onsite FOB-Hi Rapid Test. Descriptive and analytical statistical analyses were performed using Fisher's exact test and chi-square tests.

RESULTS

The FOBT kit demonstrated a sensitivity of 91% and a specificity of 100%. The number of teeth significantly influenced test results (p value = 0.021, chi-square). Age (p value = 0.09, chi-square) and sex (p value = 0.213, chi-square) did not significantly impact the test's performance.

CONCLUSION

The FOBT kit demonstrates high sensitivity (91.3%) and specificity (100%) as a screening tool for periodontal disease. Its affordability and global availability make it suitable for detecting periodontal disease across different age groups, sexes and numbers of teeth.

Glycemic Control, Inflammatory Mediators, and Periodontal Health: A Cross-Sectional Study in Patients with Diabetes

Background/Objectives: The bidirectional relationship between diabetes mellitus (DM) and periodontal disease (PD) has garnered increasing attention due to shared inflammatory mechanisms and mutual disease exacerbation. In Romania, despite a high prevalence of diabetes and PD, integration of oral health into diabetes care remains limited. This study aimed to investigate the association between glycemic control, salivary inflammatory biomarkers (IL-1β, IL-6, MMP-8), and periodontal status in diabetic patients. Additionally, it evaluated patients' awareness of oral health risks and their communication with healthcare providers regarding periodontal care. Methods: A cross-sectional, observational study was conducted between May and December 2024, involving 79 adult patients with confirmed type 1 or type 2 DM. Periodontal examinations assessed probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BOP). Salivary samples were collected to quantify IL-1β, IL-6, and MMP-8. Participants also completed a structured questionnaire on oral symptoms, hygiene practices, and awareness of the diabetes-periodontitis link. Correlation and t-test analyses were used to explore associations between clinical, biochemical, and self-reported variables. Results: Most participants had advanced periodontitis (65.8% Stage IV; 72.2% Grade C). IL-1β and IL-6 were positively correlated (r = 0.34, p < 0.01), while MMP-8 correlated with PI (r = 0.28) and BOP (r = 0.26). Inflammatory markers showed weak correlation with HbA1c. Notably, patients with higher oral health knowledge reported worse clinical indices, suggesting increased symptom awareness rather than preventive effectiveness. Conclusions: This study reinforces the inflammatory link between DM and PD and highlights the need for integrated care models. Periodontal screening and education should be embedded within diabetes management, particularly in high-risk populations.

Evaluation of salivary BDNF levels in gingivitis and periodontitis: a preliminary research

BACKGROUND

Oral health is closely related to physical health, life comfort, and functional needs. Gingivitis is a condition that means hardening of the gum tissue, prone to redness, swelling, or bleeding due to different reasons. Periodontitis damages the soft tissue around the teeth. It is a serious gum infection that destroys the bone that supports a person's teeth, if left untreated. BDNF is a member of the neurotrophin family, playing roles in the survival, growth, and function of neurons in the central and peripheral nervous system. This study aims to determine and compare salivary BDNF levels in individuals with periodontal disease and healthy controls, and to assess its relationship with clinical periodontal parameters.

METHODS

After the participants were informed and their consent was obtained, unstimulated saliva samples were taken. In our study, experimental and control groups were formed with 30 people in each group. BDNF level was measured in the saliva samples taken.

RESULTS

We found no statistically significant difference in age and gender between the healthy group, gingivitis group, and periodontitis group. There was a significant difference in the PI, GI, PPD, CAL, and BOP values in all three groups. No statistically significant difference was found when salivary BDNF levels of the groups included in the study were compared.

CONCLUSIONS

Demographic and clinical findings recorded in this study support that the amount of BDNF partially affects periodontal health parameters and neurological diseases.

Volatile sulfur compounds, biofilm, and salivary parameters in patients with periodontal disease: a cross-sectional study

This cross-sectional study aimed to evaluate the interplay between volatile sulfur compounds (VSC), biofilm, salivary parameters, and periodontal status in patients with and without periodontal disease. Sixty-four subjects diagnosed with periodontitis and 60 periodontally healthy individuals were included. Probing depth, clinical attachment level, bleeding on probing, tongue coating index, plaque index, number of teeth, spinnability of unstimulated whole saliva, and salivary flow rate were evaluated. The concentrations of VSC were quantified using a portable gas chromatograph. The mean differences in hydrogen sulfide, methyl mercaptan, salivary flow, spinnability, and plaque index did not exhibit statistically significant variances between the two groups. However, a pronounced tongue coating index and a diminished tooth count showed statistical significance in the periodontitis group (p = 0.039; p < 0.001). Unstimulated salivary flow rate less than 0.25 mL/min was statistically significant in the periodontitis group (p = 0.032). After controlling for confounding factors, bleeding on probing remained significant. A positive correlation between periodontal parameters and VSC concentration was found. An inverse correlation was also noted between the spinnability of saliva and tongue coating index (-0.34; p < 0.001). Salivary parameters may contribute to the formation of tongue coating and are correlated with periodontal status. Bleeding on probing, clinical attachment level, and probing depth were identified as potential contributors to VSC formation.

Salivary periostin levels as a non-invasive biomarker and their clinical correlates among healthy and periodontitis patients-a cross-sectional analytical study

Background

The diagnosis of periodontitis is primarily through clinical and radiographic assessments. However, it is difficult for clinicians to detect incipient periodontitis during the routine clinical assessment. Identifying people at risk for periodontitis and tracking disease development need a dependable biomarker. Currently, no biomarkers meet all the criteria required for an ideal diagnostic test. Therefore, the clinical utility of salivary periostin as a potential screening tool for periodontitis warrants further investigation, particularly through large samples across diverse populations. The present study aimed to investigate salivary periostin levels as a biomarker in individuals with periodontitis and healthy controls.

Methods

Forty-five patients with generalized periodontitis stage III grade A/B and an equivalent number of periodontally healthy controls were evaluated for plaque index (PI), gingival index (GI), pocket probing depth (PPD), and clinical attachment level (CAL). Unstimulated salivary samples from all subjects were taken, and periostin levels were quantified using an ELISA kit.

Results

The average salivary periostin levels were 4.63 in the healthy group and 1.24 in the periodontitis group (P < 0.05). The Spearman coefficient indicated a negative correlation between periostin levels and the gingival index (r = -0.761), plaque index (r = -0.780; P < 0.05), probing pocket depth (PPD) (r = -0.713; P < 0.05) and clinical attachment level (CAL) (r = -0.713; P < 0.05). Linear regression analysis validated the indirect correlation between salivary periostin levels and clinical indicators (Adjusted R square = 0.947).

Conclusions

Salivary periostin levels are associated with periodontal disease. Salivary periostin levels indirectly influence as a non-invasive biomarker of periodontitis. The biomarker periostin is effective for evaluating both healthy and diseased periodontium.

IgG In Saliva, GCF, and Serum in Young Patients With Grade C Molar Incisor Pattern Periodontitis

OBJECTIVE

This cross-sectional study aimed to investigate immunoglobulin G levels in saliva, gingival crevicular fluid, and serum samples from young patients with grade C molar incisor pattern periodontitis (C/MIP) and age-matched periodontitis-free controls.

METHODS

Saliva, gingival crevicular fluid, and blood samples were collected from 62 patients, divided into 31 cases and 31 periodontitis-free age-matched controls. Saliva and blood samples were centrifuged to extract supernatant and serum. Gingival crevicular fluid periopapers were eluted. Human total immunoglobulin G levels were assessed using an Enzyme-Linked Immunosorbent Assay.

RESULTS

After adjusting for covariates, cases had higher Immunoglobulin G levels in saliva (p = 0.005), gingival crevicular fluid (p < 0.001) than controls; however, serum did not reach the significant threshold (p = 0.137). Among other factors contributing to immunoglobulin G levels, males had higher serum immunoglobulin G than females (p = 0.018), and serum immunoglobulin G levels increased with age (p = 0.033). Gender and ethnicity subgroup analyses revealed that C/MIP males had higher saliva IgG (p = 0.018) than control males, and both genders had higher GCF IgG than controls (p ≤ 0.001). C/MIP Caucasians had elevated saliva (p = 0.011) and GCF IgG p = (0.003) compared to the controls, and Asians had higher GCF IgG than the controls (p = 0.011).

CONCLUSION

This study shows for the first time that C/MIP cases have higher Immunoglobulin G levels than controls in saliva and gingival crevicular fluid, confirming its association with C/MIP pathogenesis and suggesting that it could be a potential biomarker in grade C molar incisor pattern periodontitis. Further research on a larger sample size is needed.

Progression from healthy periodontium to gingivitis and periodontitis: Insights from bioinformatics-driven proteomics - A systematic review with meta-analysis

AIM

The current study aimed to: (1) systematically review the published literature regarding the proteomics analyses of saliva and gingival crevicular fluid (GCF) in healthy humans and gingivitis and/or periodontitis patients; and (2) to identify the differentially expressed proteins (DEPs) based on the systematic review, and comprehensively conduct meta-analyses and bioinformatics analyses.

METHODS

An online search of Web of Science, Scopus, and PubMed was performed without any restriction on the year and language of publication. After the identification of the DEPs reported by the included human primary studies, gene ontology (GO), the Kyoto encyclopedia of genes and genomes pathway (KEGG), protein-protein interaction (PPI), and meta-analyses were conducted. The risk of bias among the included studies was evaluated using the modified Newcastle-Ottawa quality assessment scale.

RESULTS

The review identified significant differences in protein expression between healthy individuals and those with gingivitis and periodontitis. In GCF, 247 proteins were upregulated and 128 downregulated in periodontal diseases. Saliva analysis revealed 79 upregulated and 70 downregulated proteins. There were distinct protein profiles between gingivitis and periodontitis, with 159 and 31 unique upregulated proteins in GCF, respectively. Meta-analyses confirmed significant upregulation of various proteins in periodontitis, including ALB and MMP9, while CSTB and GSTP1 were downregulated. AMY1A and SERPINA1 were upregulated in periodontitis saliva. HBD was upregulated in gingivitis GCF, while DEFA3 was downregulated. PPI analysis revealed complex networks of interactions among DEPs. GO and KEGG pathway analyses provided insights into biological processes and pathways associated with periodontal diseases.

CONCLUSION

The ongoing MS-based proteomics studies emphasize the need for a highly sensitive and specific diagnostic tool for periodontal diseases. Clinician acceptance of the eventual diagnostic method relies on its ability to provide superior or complementary information to current clinical assessment procedures. Future research should prioritize the multiplex measurement of multiple biomarkers simultaneously to enhance diagnostic accuracy and large study cohorts are necessary to ensure the validity and reliability of research findings.

Compatibility of salivary lactate dehydrogenase level using a test kit with the community periodontal index in Japanese adults

The purpose of this study was to investigate the association between salivary lactate dehydrogenase (LD) levels, assessed using a test kit, and the community periodontal index (CPI) and to determine the feasibility and reliability of the test kit for screening periodontal disease in adults. The study included 205 patients (58.5% female, median and 25-75 percentiles of age 55.0, 46.0-66.0 years) who visited two university hospitals and one university clinic in Japan. Resting saliva sample was collected from each participant, and LD level was evaluated in real time using a kit featuring an integer scale ranging from 1 to 10. Individual pocket scores were categorized as follows: score = 0 (≤ 3 mm), score = 1 (4-5 mm), and score = 2 (≥ 6 mm) and gingival bleeding scores were categorized as follows: score = 0 (absence of condition) and score = 1 (presence of condition). Notably, 120 participants (58.5%) exhibited a pocket score = 1 or 2, and 123 participants (60.0%) exhibited a gingival bleeding score = 1. The optimal cutoff values for salivary LD level to distinguish pocket scores = 1 or 2 from 0 and score = 2 from 0 or 1 were 4.0 and 5.0, respectively, with a sensitivity and specificity of ≥ 0.65. The median salivary LD level for a gingival score = 1 was significantly higher than that for gingival score = 0, and the optimal cutoff value for the salivary LD level was 4.0, with a sensitivity and specificity of ≥ 0.62. Our results suggested that a salivary LD level ≥ 4.0 in adults may suggest the presence of periodontal disease, thereby emphasizing the kit`s utility as a screening tool.

Microbial functional pathways based on metatranscriptomic profiling enable effective saliva-based health assessments for precision wellness

It is increasingly recognized that an important step towards improving overall health is to accurately measure biomarkers of health from the molecular activities prevalent in the oral cavity. We present a general methodology for computationally quantifying the activity of microbial functional pathways using metatranscriptomic data. We describe their implementation as a collection of eight oral pathway scores using a large salivary sample dataset (n = 9350), and we evaluate score associations with oropharyngeal disease phenotypes within an unseen independent cohort (n = 14,129). Through this validation, we show that the relevant oral pathway scores are significantly worse in individuals with periodontal disease, acid reflux, and nicotine addiction, compared with controls. Given these associations, we make the case to use these oral pathway scores to provide molecular health insights from simple, non-invasive saliva samples, and as molecular endpoints for actionable interventions to address the associated conditions.

Effect of nonsurgical periodontal therapy on salivary visfatin and serum lipid levels in obese patients with chronic periodontitis

Aim: Periodontal diseases are prevalent and can be exacerbated by conditions such as obesity. Understanding the impact of obesity on periodontal health is crucial for developing effective management strategies. This study aimed to evaluate the effect of nonsurgical periodontal therapy on salivary visfatin levels and serum lipid levels in chronic periodontitis patients with or without obesity. Methods: A total of 40 patients aged between 20 to 50 years were enrolled in the study. Group 1 (obese group) included 20 chronic periodontitis patients with obesity while Group 2 (non-obese group) included 20 chronic periodontitis patients without obesity. Gingival index (GI), probing depth (PD), clinical attachment level (CAL), salivary visfatin, and serum lipid levels were measured before and six weeks after nonsurgical periodontal therapy (NSPT). Statistical tests were done to analyze the data in the study. Results: Mean GI scores, mean PD scores, and mean CAL scores were significantly reduced before and 6 weeks after NSPT in both groups (p < 0.05). The mean salivary visfatin levels also demonstrated a statistically significant reduction between the obese and non-obese groups (p < 0.05). Similarly, the mean serum lipid levels significantly differed before and 6 weeks after NSPT in the obese group (p < 0.05). Conclusions: The current study suggests a significant correlation between GI, PD, CAL, salivary visfatin, and serum lipid levels in the obese group following NSPT.

Salivary microbiota reflecting changes in subgingival microbiota

The purpose of this study was to determine whether subgingival microbial changes according to the severity of periodontal disease and following the non-surgical periodontal treatment of periodontitis are reflected in the saliva microbiota. Subgingival and saliva samples were collected from 7 periodontally healthy controls, 14 patients with gingivitis, 12 with moderate periodontitis, and 18 with severe periodontitis. Among subjects who received treatment, seven moderate and seven severe periodontitis patients were selected for post-treatment microbial analysis, and their samples were analyzed at baseline and 6 months after treatment. The V3 and V4 regions of the 16S rRNA gene were sequenced, and correlations of the relative abundance of phyla and health- or periodontitis-dominant species between subgingival plaque and saliva samples were analyzed using Spearman signed-rank tests. Alpha diversity was higher in saliva than subgingival plaque samples, and beta diversity was significantly different between the two samples. However, levels of phyla and most health- or periodontitis-dominant species in salivary microbiota were significantly correlated with those in subgingival plaque. The improvement in clinical parameters following treatment was accompanied by a microbial shift not only in subgingival plaque but also in saliva. The abundance of 2 phyla including Bacteroidetes, 6 genera including Porphyromonas and Treponema, and 11 species including Porphyromonas gingivalis, Tannerella forsythia, and Filifactor alocis was significantly reduced in saliva following treatment. These results indicate that the salivary microbiota can reflect changes in the subgingival microbiota, suggesting that saliva can be used as a diagnostic tool to monitor the periodontal health status of individuals.

IMPORTANCE

The salivary microbiota has attracted increasing attention as a promising method for monitoring periodontal disease. With regard to the pathogenesis of periodontal disease, however, subgingival plaque microbiota is the dominant etiological factor. Although it has been established that periodontopathogenic bacteria exist in saliva and their distribution differs, depending on the severity of the disease, it is necessary to analyze the extent to which the salivary microbiota reflects the subgingival microbiota. This study explored whether subgingival microbial changes according to the severity of periodontal disease and following the non-surgical periodontal treatment of periodontitis are reflected in the saliva microbiota and concluded that the salivary microbiota can reflect changes in the subgingival microbiota. Saliva can be used as a diagnostic tool to monitor the periodontal health status of individuals.

Validating proteomic biomarkers in saliva: distinguishing between health and periodontal diseases

INTRODUCTION

Periodontitis is a chronic inflammatory disease characterized by progressive soft tissue and alveolar bone loss due to interactions between microbial dental plaque and the host response. Despite extensive research on biomarkers from saliva or gingival crevicular fluid (GCF) for diagnosing periodontitis, clinical and radiological parameters remain the primary diagnostic tools.

AREAS COVERED

This review discusses the ongoing research into salivary biomarkers for periodontitis diagnosis, emphasizing the need for reliable biomarkers to differentiate between periodontal health and disease. Salivary biomarker research has gained momentum with advancements in proteomic technologies, enabling noninvasive sample collection and revealing potential candidate biomarkers.

EXPERT OPINION

Proteomic research since the early 2000s has identified promising biomarkers and provided insights into the pathogenesis of periodontitis. Bioinformatic analysis of proteomic data elucidates the underlying biological mechanisms. This review summarizes key findings and highlights common potential biomarkers identified through proteomic research in periodontology.

Estimation of Periodontal Inflamed Surface Area by Salivary Lactate Dehydrogenase Level Using a Test Kit

Background: Salivary lactate dehydrogenase (LD) levels are a feasible and useful parameter for screening periodontal diseases. The periodontal inflamed surface area (PISA) is useful to clinically assess periodontal diseases. However, PISA is difficult to calculate and PISA-compatible screening kits are required. We aimed to investigate the association between salivary LD levels, using a test kit, and PISA and PISA-Japanese and determine the feasibility and reliability of the salivary LD test kit for evaluation of periodontal status. Methods: This study included 110 patients (66.4% female, median and 25-75 percentiles of age were 66.5 and 53.0-75.0 years, respectively) who visited the Dental University Clinic in Japan. Resting saliva samples were collected from each participant and LD levels were evaluated in real time using a kit featuring an integer scale ranging from 1 to 10. PISA and PISA-Japanese were calculated using periodontal parameters. Results: The median salivary LD level was 4.0. The medians of PISA and PISA-Japanese were 46.9 and 61.0, respectively. Salivary LD levels were positively correlated with the bleeding on probing rate (r = 0.626, p < 0.001), PISA (r = 0.560, p < 0.001), and PISA-Japanese (r = 0.581, p < 0.001). Conclusions: Our results suggest that salivary LD levels assessed using the salivary LD kit showed a significantly positive correlation with PISA and PISA-Japanese. In addition, we developed the PISA estimation formula using salivary LD levels measured with a test kit, sex, and age.

Associations between immune-inflammatory markers, age, and periodontal status: a cross-sectional study

Since periodontal disease is associated with many systemic diseases, it is important to evaluate its effects on host responses in elderly individuals. To this end, this study investigated salivary interleukin (IL)-17, IL-18, toll-like receptor (TLR) 2, TLR4, and tumor necrosis factor-alpha (TNF-α) levels in patient groups with different periodontal health statuses and immunologically evaluated the relationship between age and periodontal health status. A total of 60 individuals aged 18-40 years (young individuals) and 60 individuals aged 65 years or older (elderly individuals) were included in this study. According to periodontal disease status, the patients were divided into periodontally healthy, gingivitis, and periodontitis subgroups. Clinical periodontal parameters, including probing depth (PD), clinical attachment level (CAL), plaque index (PI), and gingival index (GI), were recorded. Saliva samples were collected and analyzed using ELISA to determine the levels of IL-17, IL-18, TLR2, TLR4, and TNF-α. Higher clinical periodontal parameter (PD, CAL, PI, and GI) and inflammatory marker (IL-17, IL-18, TNF-α, TLR2, and TLR4) levels were found in patients with periodontitis than those in periodontally healthy individuals and patients with gingivitis (P < 0.05). Salivary inflammatory marker levels were significantly higher in elderly individuals than those in young individuals in all subgroups (P < 0.05). A positive correlation was found between inflammatory marker levels and clinical periodontal parameters, but there was no correlation between TLR2 and PI or GI. This study suggests a significant increase in host response to periodontal disease as the disease progresses, with the levels of cytokines and TLR expression exhibiting an increasing trend with age. Increased IL-17, IL-18, TLR2, TLR4, and TNF-α levels in elderly individuals in all periodontal health subgroups might suggest the role of these cytokines and TLR pathway in the pathogenesis of periodontal diseases.

Exploring Salivary Metabolic Alterations in Type 2 Diabetes: Implications for Dental Caries and Potential Influences of HbA1c and Vitamin D Levels

Diabetes mellitus is considered to be the most common health issue affecting almost 1 in 11 adults globally. Oral health complications including xerostomia, periodontal disease, dental caries, and soft tissue lesions are prevalent among individuals with diabetes, and therefore an understanding of the potential association between salivary metabolites and dental caries progression would enable the early detection and prevention of this non-communicable disease. Therefore, the aim of this study was to compare salivary biomarkers between individuals with type 2 diabetes (T2DM) with those without this disorder (ND) using 1H NMR-based metabolomics strategies. The objectives were to identify T2DM-associated biomarker signatures and their potential impact on dental caries. In addition, HbA1c and vitamin D levels were also analysed for this purpose.

METHODS

Stimulated whole-mouth saliva (SWS) samples were collected from T2DM and ND (n = 30 in each case) participants randomly selected from a group of 128 participants recruited for this case-control study. All participants were advised to refrain from eating, drinking, and smoking for at least 1-2 h prior to sample collection. Following preparation, SWS supernatants underwent 1H NMR analysis at an operating frequency of 800 MHz, and the dataset acquired was analysed using a range of multivariate metabolomics techniques.

RESULTS

Metabolomics analysis of data acquired demonstrated that, together with up- and downregulated blood HbA1c and vitamin D levels, key salivary discriminators between these two classifications included lactate, taurine, creatinine, α-glucose, and formate to a lesser extent. The bacterial catabolites lactate and formate were both significantly upregulated in the T2DM group, and these have previously been implicated in the pathogenesis of dental caries. Significance analysis of metabolites (SAM)-facilitated AUROC analysis yielded an 83% accuracy for this distinction.

CONCLUSION

In conclusion, this study highlights the significant differences in salivary metabolites between individuals with T2DM and healthy controls. Such differences appear to be related to the development and progression of dental caries in T2DM patients.

Combined assessment of lysine and N-acetyl cadaverine levels assist as a potential biomarker of the smoker periodontitis

Periodontitis is an inflammatory condition of supporting structures of teeth leading to attachment and bone loss. Cigarette smoking is the single most important and modifiable risk factor with 5 to 20-fold susceptibility for periodontal diseases. Reverse smoking is a peculiar habit of smoking where the lit end is kept inside the mouth, which is predominant in the northern coastal districts of Andhra Pradesh. Polyamines are biologically active amines involved in tissue regeneration and modulation of inflammation. The study aimed to evaluate polyamines and check their utility as a marker in detection of periodontitis among different groups. Total polyamine levels showed significant increase in reverse smokers with periodontitis when compared to the other groups. Qualitative analysis by thin layer chromatography showed three polyamine bands with varying intensity among the different groups. Mass spectrometric and NMR analyses of the three bands identified them as N1, N8-diacetyl spermidine, N-acetyl cadaverine and lysine. Most significantly elevated levels of lysine was observed in the smoker and reverse smoker periodontitis groups when compared to healthy and non-smoker periodontitis groups. The significantly elevated levels of N-acetyl cadaverine could be responsible for the more destruction of periodontium in the reverse smoker group. Antioxidant potential decreased significantly in different smoker periodontitis groups. The present study suggests that the quantitative analysis of salivary polyamines, lysine and N-acetyl cadaverine can aid as an easy noninvasive diagnostic method for assessing the periodontal status, especially in smokers.

Realizing the clinical utility of saliva for monitoring oral diseases

In the era of personalized/precision health care, additional effort is being expended to understand the biology and molecular mechanisms of disease processes. How these mechanisms are affected by individual genetics, environmental exposures, and behavioral choices will encompass an expanding role in the future of optimally preventing and treating diseases. Considering saliva as an important biological fluid for analysis to inform oral disease detection/description continues to expand. This review provides an overview of saliva as a diagnostic fluid and the features of various biomarkers that have been reported. We emphasize the use of salivary biomarkers in periodontitis and transport the reader through extant literature, gaps in knowledge, and a structured approach toward validating and determine the utility of biomarkers in periodontitis. A summation of the findings support the likelihood that a panel of biomarkers including both host molecules and specific microorganisms will be required to most effectively identify risk for early transition to disease, ongoing disease activity, progression, and likelihood of response to standard periodontal therapy. The goals would be to develop predictive algorithms that serve as adjunctive diagnostic tools which provide the clinician and patient important information for making informed clinical decisions.

Comparative evaluation of salivary, serum, and GCF alkaline phosphatase levels in chronic periodontitis patients before and after nonsurgical periodontal therapy: A clinico-biochemical study

Background

Chronic periodontitis is a multifactorial disease that causes the supporting tissues around the teeth to become inflamed and destroyed, which further causes tooth mobility and eventual tooth loss. The enzyme alkaline phosphatase (ALP), which is involved in bone resorption and gingival inflammation, is an important biomarker. The current study's objective is to compare the serum, gingival crevicular fluid (GCF), and salivary levels of ALP in individuals with chronic periodontitis before and after nonsurgical periodontal therapy.

Materials and Methods

On the basis of clinical and radiographic examinations, 72 participants were split into two groups: Group I (healthy individuals) and Group II (chronic periodontitis patients). All patients who were in an aseptic condition had their serum, GCF, and unstimulated saliva taken, and samples were then tested for ALP levels using ALP kit.

Results

The difference in salivary, serum, and GCF ALP levels between the control group (23.44 ± 4.76, 58.88 ± 8.29, and 776.76 ± 121.91) and the study group (105.66 ± 16.33, 102.38 ± 4.43, and 1,825.77 ± 275.12) was found to be statistically significant with P < 0.001. The difference in salivary, serum, and GCF ALP levels from baseline (105.66 ± 16.33, 102.38 ± 4.43, and 1,825.77 ± 275.12) to postoperative (49.54 ± 5.69, 83.46 ± 4.22, and 1,148.38 ± 129.01) was found to be statistically significant with P < 0.001. The results demonstrated that patients with chronic periodontitis have considerably higher levels of serum, GCF, and salivary ALP than healthy individuals.

Conclusion

Salivary and GCF ALP can thus be used as a key inflammatory diagnostic biomarker in periodontal diseases.

Assessment of Salivary MMP-8 and IL-1β for the Diagnosis of Periodontal Diseases in Pakistani Population

OBJECTIVE

 Clinical methods use the subjective diagnosis of periodontal diseases by visual observation that could result in differences and variability of diagnosis. The addition of specific markers could aid in the accurate diagnosis of the local population. The objective of the study was to target two of the major proteins for possible significance in such an approach.

MATERIALS AND METHODS

 Unstimulated saliva samples were collected from 60 participants aged between 18 and 70 years. Three groups each with twenty participants were recruited into periodontitis, gingivitis, and healthy control.

STATISTICAL ANALYSIS

 The samples were analyzed using human enzyme-linked immunosorbent assay kits for matrix metalloproteinase-8 (MMP-8) and interleukin-1β (IL-1β).

RESULTS

 SPSS version 20 was used to analyze the result. Posthoc analysis by Tukey's test revealed that MMP-8 levels were higher in gingivitis and periodontitis groups as compared with healthy controls. The test also revealed that IL-1β levels were higher in the periodontitis group compared with the healthy control and gingivitis group. Additionally, one-way analysis of variance analysis showed a significant effect on probing depth in gingivitis and periodontitis patients. The mean age of periodontitis group was significantly higher than other groups.

CONCLUSION

 Salivary biomarkers may provide useful diagnostic information and could be utilized as tests for periodontal disease screening, prognosis, and prediction.

The evaluation of salivary leucine-rich alpha-2 glycoprotein (LRG) and C-reactive protein (CRP) in humans with periodontal health or periodontal disease

OBJECTIVE

The purpose of the present research is to evaluate the salivary levels of leucine-rich alpha-2 glycoprotein (LRG) and C-reactive protein (CRP) in periodontal health and disease (gingivitis and stage III periodontitis) and also to compare the discriminative efficiencies of both biomarkers in periodontal disease.

BACKGROUND

LRG is a new acute-phase protein whose functions are still being investigated. LRG and CRP are both biomarkers that are increased by inflammation. No clinical study has yet investigated the comparison of the level of LRG and CRP in periodontal health, gingivitis and periodontitis in saliva samples.

METHODS

A total of 60 individuals, including 20 periodontally healthy (control group/group C), 20 with gingivitis (group G), and 20 with Stage III periodontitis (group P), who were systemically healthy and non-smokers, participated in this study. Periodontal charts were used for recording clinical periodontal parameters and saliva LRG and CRP levels were measured by ELISA. Analyzing the area under the curve (AUC) was performed by the receiver-operating characteristics curve.

RESULTS

Salivary levels of LRG and CRP were significantly higher in disease groups than in group C (p < .05). Positive statistically significant correlations were observed between both biomarkers and clinical parameters (p < .05). There was also a strong positive correlation between two biomarkers (p < .05). In distinguishing periodontal disease from periodontal health, LRG (AUC = 0.833) and CRP (AUC = 0.826) were found to have similar accuracy (p = .923).

CONCLUSION

LRG and CRP may be useful and similarly effective biomarkers in the diagnosis of periodontal diseases based on the findings of this study.

Saliva sampling method influences oral microbiome composition and taxa distribution associated with oral diseases

Saliva is a readily accessible and inexpensive biological specimen that enables investigation of the oral microbiome, which can serve as a biomarker of oral and systemic health. There are two routine approaches to collect saliva, stimulated and unstimulated; however, there is no consensus on how sampling method influences oral microbiome metrics. In this study, we analyzed paired saliva samples (unstimulated and stimulated) from 88 individuals, aged 7-18 years. Using 16S rRNA gene sequencing, we investigated the differences in bacterial microbiome composition between sample types and determined how sampling method affects the distribution of taxa associated with untreated dental caries and gingivitis. Our analyses indicated significant differences in microbiome composition between the sample types. Both sampling methods were able to detect significant differences in microbiome composition between healthy subjects and subjects with untreated caries. However, only stimulated saliva revealed a significant association between microbiome diversity and composition in individuals with diagnosed gingivitis. Furthermore, taxa previously associated with dental caries and gingivitis were preferentially enriched in individuals with each respective disease only in stimulated saliva. Our study suggests that stimulated saliva provides a more nuanced readout of microbiome composition and taxa distribution associated with untreated dental caries and gingivitis compared to unstimulated saliva.

Comparative Evaluation of C-Reactive Protein Levels among Peri-Implant Health and Disease Conditions

Peri-implant disease pathogenesis results in production of pro-inflammatory mediators, among which C-reactive protein (CRP) is one of the acute phase reactants. The aim of the study was to comparative CRP levels among peri-implant health and disease conditions. The present study was carried out in the Department of Implantology, Saveetha Dental College and Hospitals, Chennai, India. A total of 40 patients with peri-implant health (n = 10), peri-mucositis (n = 10), early peri-implantitis (n = 10) and advanced peri-implantitis (n = 10) were enrolled. Unstimulated salivary samples were collected and subjected to latex agglutination assay for CRP analysis. CRP levels were then correlated with peri-implant health and diseases. CRP level in peri-implant health, peri-implant mucositis, early peri-implantitis and advanced peri-implantitis were 0.18 ± 0.04 mg/dL, 2.05 ± 0.61 mg/dL, 4.14 ± 1.82 mg/dL and 6.21 ± 1.35 mg/dL respectively. There was a statistically significant difference in CRP levels between all the tested groups (ANOVA, P = 0.03). Pearson correlation coefficient analysis revealed a strong positive correlation between CRP and peri-implant health status. CRP level was high among patients with peri-implantitis followed by peri-implant mucositis and peri-implant health. Also, CRP level increases with severity of peri-implant diseases and there exists a positive correlation between CRP level and peri-implant health status.

A novel plasmonic optical-fiber-based point-of-care test for periodontal MIP-1α detection

The analysis of salivary biomarkers as expression of periodontal health conditions has been proposed as a useful aid to conventional diagnostic approaches. In this study, we present a point-of-care test (POCT) exploiting a surface plasmon resonance (SPR)-based optical biosensor to detect salivary macrophage inflammatory protein (MIP)-1α, a promising marker of periodontitis. A plastic optical fiber (POF) was suitably modified and functionalized by an antibody self-assembled monolayer against MIP-1α for plasmonic detection. The proposed SPR-POF biosensor showed high selectivity and very low limit of detection for MIP-1α of 129 fM (1.0 pg/mL) in phosphate-buffered saline and 346 fM (2.7 pg/mL) in saliva. As a proof of concept, this POCT was also able to discriminate between a periodontitis patient and a healthy subject. The obtained results support the future application of this technology for an on-site detection and real-time monitoring of periodontal health conditions for diagnostic and therapeutic purposes.

Effects of the Saliva of Patients Undergoing Orthodontic Treatment with Invisalign and Brackets on Human Gingival Fibroblasts and Oral Epithelial Cells

The transient worsening of oral health sometimes accompanies orthodontic treatment (OT), and the extent of this effect might depend on whether the patients are treated with traditional brackets or clear aligners. Saliva is an important tool for monitoring oral health and influences the functional properties of various oral cells. This study aimed to compare the effects of saliva from patients undergoing OT with Invisalign aligners and brackets on human gingival fibroblasts and oral epithelial cells in vitro. Unstimulated saliva was collected from 15 patients treated with Invisalign and 16 patients treated with brackets before and 3 and 6 months after therapy began. The saliva was used to stimulate primary human gingival fibroblasts and the oral epithelial Ca9-22 cell line, and the resulting cell response was investigated. Saliva did not exhibit any toxic effect on investigated cells, as shown by the proliferation/viability assay with the MTT method. In human gingival fibroblasts, saliva increased gene expression of various proinflammatory mediators, such as interleukin (IL)-6, IL-8, and monocyte chemoattractant protein-1, assessed by qPCR. In epithelial cells, saliva increased the production of IL-8 measured by ELISA and decreased gene expression of various proteins involved in the barrier function. During the therapy, the saliva-induced production of IL-8 tended to be decreased, and the saliva-induced decrease in the expression of barrier protein was partially improved. No difference between aligners and brackets was observed in either cell type. Saliva affects the functional properties of oral cells, but this effect is not influenced by the type of OT.

Physiotherapeutic Approach in Oral Submucous Fibrosis: A Systematic Review

One of the most poorly recognized and inadequately managed diseases, oral submucous fibrosis progresses over time. Betel nut eating is the foremost cause of oral submucous fibrosis. One such condition is oral submucous fibrosis, which is characterized by severe trismus, disability, and a higher risk of cancer. The mouth opening gradually decreases, which is related to difficulty eating, altered gustatory sensation, and mouth dryness, leading to decreased oral intake. The main and beginning signs include decreased mouth opening, pain, difficulty eating, dry mouth, and blanching of the buccal mucosa. This is treated first with medication, then with exercises for the mouth that a physiotherapist has recommended. However, the function of a physical therapist is not clearly defined. Physiotherapy may be used with other therapies to treat oral submucous fibrosis. Mouth-opening exercises, ultrasound, and other therapeutic interventions are available. This article tries to describe the kind of physical therapy that can be recommended for treating oral submucous fibrosis. It is crucial to understand pain management, physiotherapy management for grade III and IV oral submucous fibrosis various additional exercises, modalities and their ideal dose, and strategy for the long-term effect of the treatments to conduct further research.

Salivary Amylase and Mucin in Chronic Periodontitis: Pre- /Posttherapy

AIM

The study aims to investigate the potential of salivary amylase as a reliable biochemical marker for assessing periodontal disease progression, establishing a potential correlation between salivary amylase levels and periodontal disease severity.

MATERIALS AND METHODS

The study included 40 participants, aged 25-65, equally divided into a control and study group of 20 individuals each. Clinical parameters, such as oral hygiene index, gingival index, probing depth, and clinical attachment level were recorded. Saliva samples were collected and analyzed for amylase and mucin levels using a semi-auto analyzer and spectrophotometer, respectively. These clinical parameters and salivary biomarkers were evaluated before and after 45 days of phase I periodontal therapy. Statistical analysis, including independent samples t-test, paired samples t-test, and correlation analysis were performed to assess the treatment effectiveness and explore associations between clinical parameters and salivary biomarkers.

RESULTS

The study group with chronic generalized periodontitis showed significantly higher salivary amylase (27022.5 ± 8598.9) and mucin levels (3258 ± 724.2) and worse clinical parameters than the control group at baseline. However, after phase I periodontal therapy, the study group exhibited reduced salivary biomarkers amylase (17924.0 ± 4703.6) and mucin (1828.45 ± 314.07) and improved clinical parameters, indicating the effectiveness of the treatment in enhancing periodontal health compared with the control group. Positive correlations were found between clinical parameters and salivary amylase/mucin levels both before and after therapy (p < 0.001).

CONCLUSION

Salivary amylase and mucin levels hold promise as valuable biomarkers for diagnosing active periodontal disease and evaluating treatment outcomes after phase I therapy.

CLINICAL SIGNIFICANCE

Salivary biomarker comparison offers a noninvasive diagnostic tool for periodontal disease, improving early detection and personalized treatment planning. Further research is required to validate its clinical value fully.

Soluble Receptor Activator of Nuclear Factor Ligand and Osteoprotegerin Levels in Gingival Crevicular Fluid among Cigarette Smokers and Non-smokers with and without Periodontitis

AIM

This study aimed to measure and compare the levels of soluble receptor activator of nuclear factor ligand (RANKL) and osteoprotegerin (OPG) in the gingival crevicular fluid (GCF), as well as their ratio, in smokers and nonsmokers with periodontitis.

MATERIALS AND METHODS

Gingival crevicular fluid samples were collected using PerioPaper strips, from 150 individuals, who were categorized into three groups: current smokers with periodontitis stage III grades C and B (n = 50), nonsmokers with periodontitis stages I and II grade A (n = 50), and control healthy individuals (n = 50). The concentrations (pg/mL) of sRANKL and OPG in the GCF were measured by enzyme-linked immunesorbent assays (ELISA).

RESULT

The smokers' group exhibited the highest sRANKL (pg/mL) concentration as a subsequent lead to a higher sRANKL/OPG ratio. The healthy control group exhibited higher OPG and lower sRANKL concentration, subsequently, the sRANKL/OPG ratio was reduced compared with the other study groups. However, there was no statistical significance of sRANKL and its relative ratio between periodontitis stage III grades C and B, periodontitis stages I and II grade A, and healthy control individuals. There was a statistically significant positive moderate correlation between smoking duration (years) and the sRANKL (pg/mL) concentration and a statistically significant negative moderate correlation between OPG (pg/mL) concentration and cigarettes smoked per day.

CONCLUSION

As a result, compared to the other research groups, smokers with periodontitis stage III grades C and B had greater GCF concentrations of sRANKL, lower OPG, and a higher sRANKL/OPG ratio. The difference in OPG (pg/mL) level was statistically significant. However, there was no statistically significant difference in sRANKL (pg/mL) or its relative ratio, sRANKL/OPG, across the groups.

CLINICAL SIGNIFICANCE

A characteristic that sets periodontitis apart is alveolar bone loss. Resorption is induced by RANKL and inhibited by OPG, resulting in a relative ratio. In light of this, the levels of RANKL and OPG may be helpful indicators for monitoring the activity of periodontal disease in both smokers and nonsmokers with and without periodontitis.

Complement components C3b and C4b as potential reliable site-specific diagnostic biomarkers for periodontitis

OBJECTIVE

This study aimed to investigate the correlation between the expression levels of C3b and C4b in human gingival tissue (GT) and gingival crevicular fluid (GCF) and disease severity in human periodontitis and to determine whether C3b and C4b are significant site-specific complementary diagnostic markers for periodontitis.

BACKGROUND

A variety of biomarkers that have potential for informing diagnoses of periodontitis have been proposed. The complement components C3b and C4b were found to be positively correlated with disease severity. The therapeutic effect of targeting C3b and C4b on inflammatory bone loss in experimental periodontitis models has been studied. However, studies on the diagnostic potential of the gingival C3b and C4b expression levels for periodontitis are scarce.

METHODS

The expression levels of C3b and C4b in the GT and GCF were investigated via immunohistochemistry and enzyme-linked immunosorbent assay, respectively. The correlation between the expression levels of C3b and C4b and disease severity with probing depth as well as the clinical attachment level were determined. To evaluate the diagnostic accuracy of the C3b and C4b expression levels at the periodontitis sites, the receiver operating characteristic (ROC) curve, cut-off point, area under the ROC curve, sensitivity, and specificity were analyzed.

RESULTS

The expression levels of C3b and C4b in human GT and GCF were significantly positively correlated with periodontitis severity. The expression levels of combined C3b + C4b in the GT can significantly differentiate the disease status at the tissue level (p < .0001). Similarly, the expression levels of C3b + C4b in GCF can statistically distinguish periodontitis sites from healthy ones (p < .0001).

CONCLUSIONS

Locally deposited C3b and C4b were positively correlated with periodontitis severity and recognized as site-specific diagnostic biomarkers for clinicopathological features in periodontitis. The association between the C3b and C4b network and periodontitis may be further understood and provide a basis for the development of novel screening as well as diagnostic and therapeutic strategies for periodontitis.

Biomarkers for diagnosis of stage III, grade C with molar incisor pattern periodontitis in children and young adults: a systematic review and meta-analysis

AIM

To explore the existing salivary, gingival crevicular fluid (GCF), blood, and serum biomarkers associated with grade C molar-incisor pattern (C/MIP) periodontitis in systemically healthy children and young adults.

MATERIALS AND METHODS

Cross-sectional, case-control, and cohort studies on stage III grade C periodontitis or former equivalent diagnosis with analysis of molecular biomarkers in saliva, GCF, blood, or serum were retrieved from six databases and screened based on the eligibility criteria. The risk of bias in included studies was evaluated. Meta-analysis was planned for biomarkers assessed using the same detection methods and sample type in at least two papers.

RESULTS

Out of 5621 studies identified at initial screening, 28 papers were included in the qualitative analysis of which 2 were eligible for meta-analysis for IgG in serum samples. Eighty-seven biomarkers were assessed with the majority being higher in cases than in controls. Only the meta-analysis of total serum IgG with low heterogeneity value revealed a significant increase in its levels in C/MIPs compared to controls (standardised mean difference: 1.08; 95% CI: 0.76, 1.40).

CONCLUSION

There is a paucity of data on biomarkers associated with molar-incisor pattern periodontitis. Although serum IgG levels are raised, other more specific biomarkers in saliva, GCF, and blood/serum may be promising but require further investigation.

Comparative clinical evaluation of a local drug delivery of cranberry and garcinia fruit gel with tetracycline fibers for amelioration of periodontitis: A split mouth study

Background

The present study formulates and evaluates a polyberry gel comprising extracts of cranberry (Vaccinium macrocarpon) and brindle berry (Garcinia cambogia) in patients suffering from chronic periodontitis.

Materials and Methods

The polyberry gel was evaluated for various physicochemical parameters, in vitro permeability and stability, and the active phytoconstituents were quantified by High-performance thin layer chromatography (HPTLC). Total phenolic content, total antioxidants, and ascorbic acid were estimated in the two extracts by in vitro assays. Patients suffering from chronic periodontitis with probing pocket depth (PPD) up to 5 mm were divided into 3 groups of 21 patients each and treated with scaling and root planing (SRP) or SRP followed by subgingival placement of polyberry gel or tetracycline fibers (standard). Plaque Index (PI), Gingival Index (GI), PPD, Clinical Attachment Level (CAL), and the salivary aspartate aminotransferase (AST) and C-reactive protein (CRP) levels were recorded at baseline and after 1 month.

Results

A significant (P < 0.01) reduction in the periodontic disease parameters was observed in the standard and gel-treated groups between their baseline and 1-month time-interval readings. The polyberry gel treatment significantly (P < 0.05 for AST and P < 0.01 for the rest) attenuated the periodontitis-elevated PI, GI PPD, CAL, AST and CRP levels when compared with SRP at the end of the study and was comparable with tetracycline.

Conclusion

The amelioration of periodontitis and gingival inflammation may be attributed to the potent antioxidant activity of the polyphenolic phytoconstituents of the gel. The polyberry gel may thus be used as a safe adjunct to SRP/tetracycline in chronic periodontitis.

Non-invasive diagnostic potential of salivary miR-25-3p for periodontal disease and osteoporosis among a cohort of elderly patients with type 2 diabetes mellitus

OBJECTIVE

Osteoporosis (OP) and periodontal disease (PD) are two common health issues that threaten the older population and potentially connected each other in the context of type 2 diabetes mellitus (T2DM). Dysregulated expression of microRNAs (miRNAs) may contribute to the development and progression of both OP and PD among elderly T2DM patients. The present study aimed to evaluate the accuracy of miR-25-3p expression for the detection of OP and PD when compared to a mixed group of patients with T2DM.

METHODS

The study recruited 45 T2DM patients with normal bone mineral density (BMD) and healthy periodontium, 40 type 2 diabetic osteoporosis patients coexistent with PD, 50 type 2 diabetic osteoporosis patients with healthy periodontium, and 52 periodontally healthy individuals. miRNA expression measurements in the saliva were determined by real-time PCR.

RESULTS

The salivary expression of miR-25-3p was higher in type 2 diabetic osteoporosis patients than patients with T2DM only and healthy individuals (P < 0.05). Among type 2 diabetic osteoporosis patients, those with PD exhibited a higher salivary expression of miR-25-3p than those with healthy periodontium (P < 0.05). Among type 2 diabetic patients with healthy periodontium, a higher salivary expression of miR-25-3p was noted in those with OP than those without (P < 0.05). We also found a higher salivary expression of miR-25-3p in T2DM patients than healthy individuals (P < 0.05). It was revealed that the salivary expression of miR-25-3p was increased as the T scores of BMD of patients were lowered, the PPD and CAL values of patients were enhanced. The salivary expression of miR-25-3p used as a test to predict a diagnosis of PD among type 2 diabetic osteoporosis patients, a diagnosis of OP among type 2 diabetic patients, and a diagnosis of T2DM among healthy individuals produced AUC of 0.859. 0.824, and 0.886, respectively.

CONCLUSION

The findings obtained from the study support salivary miR-25-3p confers non-invasive diagnostic potential for PD and OP among a cohort of elderly T2DM patients.

An optical fiber-based point-of-care test for periodontal MMP-8 detection: a proof of concept

OBJECTIVES

The evaluation of salivary biomarkers has been proposed as a simple and non-invasive aid to the conventional periodontal diagnosis based on clinical-radiographic parameters. Matrix metalloproteinase-8 (MMP-8), especially in its active form, is considered one of the most reliable biomarkers of periodontitis, and point-of-care tests (POCTs) have been proposed for its clinical monitoring. In this proof-of-concept study, a novel highly sensitive POCT based on a plastic optical fiber (POF) biosensor exploiting surface plasmon resonance (SPR) to detect salivary MMP-8 is described.

METHODS

A SPR-POF biosensor was functionalized with a specific antibody to develop a surface-assembled monolayer (SAM) for the detection of total MMP-8. A white light source and a spectrometer connected to the biosensor were used to quantify MMP-8 level in both buffer and real matrix (saliva) by analysing the shift of the resonance wavelength determined by the specific antigen-antibody binding upon the SAM.

RESULTS

Dose-response curves by serial dilutions of human recombinant MMP-8 were realized, obtaining a limit of detection (LOD) of 40 pM (1.76 ng/ml) in buffer and 225 pM (9.9 ng/ml) in saliva and high selectivity compared to interferent analytes (MMP-2 and IL-6).

CONCLUSIONS

The proposed optical fiber-based POCT was able to detect and measure total MMP-8 with high selectivity and very low LOD in both buffer and saliva.

CLINICAL SIGNIFICANCE

The SPR-POF technology may be employed to create highly sensitive biosensors to monitor salivary MMP-8 levels. The possibility of specifically detecting its active, rather than total, form need to be further investigated. If confirmed and clinically validated, such a device may represent a promising tool to make an immediate, highly sensitive and reliable diagnosis of periodontitis, and to carry out a timely and targeted therapy, possibly helping to prevent the onset of local and systemic periodontitis-related complications.

Assessment and Correlation of Salivary Ca, Mg, and pH in Smokers and Non-Smokers with Generalized Chronic Periodontitis

Background and Objectives: Diagnostic evaluation with the aid of biomarkers has reached newer heights to assess disease activity. Salivary calcium, magnesium, and pH are one of the biochemical parameters which can be helpful in assessing the progression of periodontal disease. Smokers are at topnotch threat for having oral diseases, predominantly periodontal diseases. The aim of this study was to assess the salivary calcium, magnesium, and pH levels in smokers compared with non-smokers with chronic periodontitis. Materials and Methods: The current study was conducted on 210 individuals affected with generalized chronic periodontitis, with the age group between 25 and 55 years. Based on their smoking habit, an equal number of patients were categorized into two groups; namely, group I consisted of non-smokers and group II consisted of smokers. The clinical parameters that were measured included Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), and Clinical Attachment Loss (CAL). The biochemical variables that were evaluated in the current study included salivary calcium, magnesium, and pH using an AVL9180 electrolyte analyzer (Roche, Germany). The gathered data were analyzed with an unpaired t test was using SPSS 20.0. Results: A statistically significant higher PPD (p < 0.01), CAL (p < 0.05), and salivary calcium levels (p < 0.001) were observed in the smokers' compared with their non-smoking counterparts. Among the biochemical parameters, calcium showed a significantly (p < 0.001) higher level in smokers (5.79 ± 1.76) in contrast to non-smokers (3.87 ± 1.03). Additionally, a significant negative correlation (p < 0.05) between calcium and PPD was observed in non-smokers, whereas a non-significant inverse relation (p > 0.05) was seen in smokers. Conclusions: The present study indicates that the salivary calcium level can be a potential biochemical parameter to assess the progression of periodontal disease in smokers and non-smokers. Within the limitations of the current study, the salivary biomarkers appear to have an essential role in the identification and indication of the status of periodontal diseases.

Salivary histone deacetylase in periodontal disease: A cross-sectional pilot study

OBJECTIVE

The objective of the study was to profile the expression level of histone deacetylase enzymes (HDACs) in human saliva in periodontal health, gingivitis and periodontitis.

BACKGROUND

HDACs are epigenetic modulators and a group of enzymes that catalyse the removal of acetyl functional groups from the lysine residues of both histone and nonhistone proteins. HDACs have been detected in gingival tissues and may provide valuable insight into the periodontal inflammatory response. However, no studies have investigated the expression of HDACs in saliva from periodontitis-affected individuals and their capacity for periodontal diagnostics and screening.

MATERIALS AND METHODS

Whole unstimulated saliva was collected from 53 participants (17 healthy, 14 gingivitis and 22 stages III/IV periodontitis). The expression of 11 HDACs in saliva samples was determined using RT-qPCR and diagnostic power was calculated using the receiver operating characteristic (ROC) curves and area under the ROC Curve (AUC).

RESULTS

Relative to health, the expression of HDAC4, 8 and 10 was downregulated in gingivitis, and the expression of HDAC4, 6, 8 and 9 was downregulated in periodontitis. Increased HDAC1 and decreased HDAC9 expression were observed in periodontitis compared to gingivitis. Higher HDAC1 and lower HDAC6 and 9 expression was observed in periodontitis compared to non-periodontitis (combining health and gingivitis). Expression of HDAC3, 4, 8, 9 and 10 was significantly decreased in periodontal disease (combining gingivitis and periodontitis) compared to health. HDAC4 and 8 exhibited an excellent diagnostic capacity for distinguishing gingivitis and periodontal disease from health (AUC 0.79-0.86). HDAC9 showed an acceptable power in discriminating periodontitis from health, gingivitis and non-periodontitis (AUC 0.76-0.80). Salivary HDAC enzyme activity showed no significant difference among the groups.

CONCLUSION

This pilot study has demonstrated the differential expression of HDACs in human saliva for the first time and identified HDAC4, 8 and 9 as potential biomarkers in periodontal diagnosis.

Salivary leukocyte esterase activity by SillHa is a risk indicator of periodontal disease

BACKGROUND

There is increasing evidence that diagnostic salivary tests measuring inflammatory biomarkers are being developed to assess inflammatory status for early detection, prevention, and progression of periodontal disease. Therefore, the aim of the present study was to investigate and identify the salivary biomarker that can predict the inflammatory status of periodontal disease.

METHODS

A total of 36 patients (28 women and 8 men) with an average age of 57 years were investigated. Unstimulated saliva was collected from the recruited subjects and analyzed using SillHa, a saliva-testing device that measures bacteria count, saliva buffer capacity, acidity, leukocyte esterase, protein, and ammonia. Periodontal parameters were then obtained by clinical examination and initial periodontal therapy was performed. Data obtained with SillHa were compared with clinical periodontal parameters at baseline, re-examination (three months from baseline), and final examination (six months from re-examination).

RESULTS

Leukocyte esterase activity in saliva measured by SillHa; BOP and PCR measured by clinical examination showed a significant difference between baseline and final examination and between re-examination and final examination. Patients in the lower median group (group 1) had a significant difference in leukocyte esterase activity between baseline and final examination and re-examination and final examination. In addition, patients in Group 1 had significantly lower BOP between baseline and final examination. While patients in the higher median group (group 2) showed a modest decrease in leukocyte esterase activity, which was significant only between baseline and final examination, no significant changes were observed concerning BOP. Furthermore, the associated systemic disease was observed in 30% and 81.2% of group 1 and 2 patients, respectively.

CONCLUSION

The results suggest that leukocyte esterase activity in saliva measured by SillHa could serve as a reliable diagnostic marker for monitoring inflammatory status in periodontal disease.

The paradigm of miRNA and siRNA influence in Oral-biome

Short nucleotide sequences like miRNA and siRNA have attracted a lot of interest in Oral-biome investigations. miRNA is a small class of non-coding RNA that regulates gene expression to provide effective regulation of post-transcription. On contrary, siRNA is 21-25 nucleotide dsRNA impairing gene function post-transcriptionally through inhibition of mRNA for homologous dependent gene silencing. This review highlights the application of miRNA in oral biome including oral cancer, dental implants, periodontal diseases, gingival fibroblasts, oral submucous fibrosis, radiation-induced oral mucositis, dental Pulp, and oral lichenoid disease. Moreover, we have also discussed the application of siRNA against the aforementioned disease along with the impact of miRNA and siRNA to the various pathways and molecular effectors pertaining to the dental diseases. The influence of upregulation and downregulation of molecular effector post-treatment with miRNA and siRNA and their impact on the clinical setting has been elucidated. Thus, the mentioned details on application of miRNA and siRNA will provide a novel gateway to the scholars to not only mitigate the long-lasting issue in dentistry but also develop new theragnostic approaches.

Glycemic and Insulin Status in Periodontitis Patients using the Homeostasis Model Assessment (HOMA): A Pilot Study

PURPOSE

This study aimed to compare insulin status and dysglycemia (prediabetes/diabetes) of patients with chronic (stage III, grade B) or aggressive periodontitis (stage III, grade C) to that of a healthy population.

MATERIALS AND METHODS

Patients with chronic (CP, n = 16) or aggressive periodontitis (AP, n = 15) and periodontally healthy controls (n = 32) were recruited. Body mass index was calculated. Glycemia, plasma insulin, glycated hemoglobin, C-reactive protein, and lipid levels were measured in fasting. The Homeostasis Model Assessment was used to calculate the insulin sensitivity (HOMA-%S), the beta-cell function (HOMA-%B), and their hyperbolic product (HOMA-%BxS).

RESULTS

The CP group showed statistically significantly insulin resistance with a lower HOMA-%S (p = 0.0003) and a reduced HOMA-%BxS (p = 0.049) despite a higher insulin level (p = 0.01) vs the control group, even after BMI adjustment. There was also a trend to dysglycemia (prediabetes/diabetes) in the chronic group. In patients with AP, no abnormalities in insulin status were observed and glycemic levels were comparable with controls. Additionally, patients in both AP and CP groups presented significantly higher CRP levels compared to those of the control group (p = 0.02).

CONCLUSION

Patients with CP showed reduced insulin sensitivity, increased insulin levels but a reduced %BxS product and a trend to dysglycemia. These abnormalities were not observed in AP.

TNFα, IL-6, miR-103a-3p, miR-423-5p, miR-23a-3p, miR-15a-5p and miR-223-3p in the crevicular fluid of periodontopathic patients correlate with each other and at different stages of the disease

Periodontitis is one of the main frequent intraoral diseases. Pathogenesis triggers are the immune responses with pro-inflammatory cytokines production and non-coding RNAs expression. The purpose of the present study was to evaluate the involvement of selected miRNAs in various stages of periodontitis and their relationship with the levels of inflammatory mediators in gingival crevicular fluid (GCF). For this study, 36 subjects (21 with periodontal disease, 15 healthy controls) were selected with an age mean of 59.1 ± 3.7 years. Clinical parameters included plaque index, gingival index, sulcus bleeding index, pocket depth, and clinical attachment level. The GCF samples were taken using capillary paper. The levels of miRNAs in GCF were estimated using a Real-Time PCR and TNFα and IL-6 levels were assessed by enzyme-linked immunosorbent assay (ELISA). The results indicated that the miRNA-103a-3p, miRNA-23a-3p, miRNA-15a-5p, and miRNA-223-3p were significantly upregulated with respect to healthy controls. Significant differences were observed for miRNA-23a-3p, miRNA-103a-3p and miRNA-423-5p levels in accord with the disease stages. Inflammatory mediators evaluated in GCF correlate well with the clinical parameters and the severity of the periodontal disease. miRNAs can represent biomarkers of disease stage and can be investigated as a possible therapeutic target, as well as levels of TNFα and IL-6 may drive the disease progression by acting as prognostic markers.

Proteomic Identification of Saliva Proteins as Noninvasive Diagnostic Biomarkers

Many biomedically relevant biomarkers are proteins with characteristic biochemical properties and a relatively restricted subcellular distribution. The comparative and mass spectrometry-based proteomic analysis of body fluids can be particularly instrumental for the targeted identification of novel protein biomarkers with pathological relevance. In this respect, new research efforts in biomarker discovery focus on the systematic mapping of the human saliva proteome, as well as the pathobiochemical identification of disease-related modifications or concentration changes in specific saliva proteins. As a product of exocrine secretion, saliva can be considered an ideal source for the biochemical identification of new disease indicators. Importantly, saliva represents a body fluid that is continuously available for diagnostic and prognostic assessments. This chapter gives an overview of saliva proteomics, including a discussion of the usefulness of both liquid chromatography and two-dimensional gel electrophoresis for efficient protein separation in saliva proteomics.

CC group of chemokines and associated gene expression of transcription factors: Deciphering immuno-pathogenetic aspect of oral submucous fibrosis

BACKGROUND

Oral submucous fibrosis (OSMF) is a chronic disease with significantly increasing malignant transformation rate. To date the pathogenesis of OSMF has been considered to be associated with areca nut constituents and their action on fibroblasts. However, fibrosis is also associated with immunological factors such as chemokines. In-depth analysis of such factors is the need of the hour in OSMF to better understand the pathogenesis so that effective therapeutic strategies can be developed in the future.

MATERIALS AND METHOD

Clinically diagnosed cases of OSMF (n=21) and healthy individuals (n=10) were enrolled in the present study. Chemokines such as CCL2, CCL3, CCL4, CCL5, CCL11, CCL17, CCL28, CXCL1, CXCL5, CXCL8, CXCL9, CXCL10, and CXCL11 were assessed using the chemokine bead array in conjunction with the flow cytometry, along with real-time PCR (RT-PCR). The transcription factors CREB, NF-κB and NFAT5 were also studied for their expressions. The analysis of pg/ml (picogram/milliliter) values was done by using LEGENDplex™ Data Analysis Software.

RESULTS

The results obtained demonstrated early phase transient increase in CXCL-11, CCL20, CXCL9, CCL3, CCL2, CXCL10 and CXCL8. However, the expression of CCL3, CXCL10 and CXCL8 was higher in the late stage as compared to the early stage. The relative gene expression of CREB, NF-κB, NFAT5 were upregulated in the late stage of OSMF when compared to normal.

CONCLUSION

Distinctive sets of chemokine expression during the early and late stages of OSMF suggest a unique pattern of disease progression playing an important role in the pathogenesis.

Peri-implant Bone Healing: Its Basic Osteogenesis and Biomarkers

The continuous sequence of bone healing phases starts off with osteoconduction to the implant surface, depending on the migration of osteogenic cells. Osteoneogenesis ensues resulting in a mineralised interfacial matrix and is followed by bone remodelling to the implant interface at discrete sites. Dental implant drilling procedure and placement produce osseous defect which is filled by blood. Within seconds, blood proteins are adsorbed onto the implant surface and platelets are activated resulting in the release of cytokines and growth factors. Further platelet aggregation initiates osteoconduction to the surface, followed by osteoneogenesis, forming an extracellular matrix. Subsequently, remodelling creates a bone to implant interface which can be explained through distance and contact osteogenesis. The dental implant surface has been shown to influence osteoconduction by modifying protein properties and adsorption around the implant. Salivary biomarkers may be considered as a specific and sensitive diagnostic tool to detect these changes in protein expressions after implant placement. Thus, the purpose of this narrative review is to provide a detailed account of the bone healing mechanism associated with dental implant placement, as well as how the implant surface architecture and protein release play a role in bone healing, and the potential use of saliva to detect these biomarkers.

Evaluation of Treatment with Omega-3 Fatty Acid Supplements on Salivary Levels of Resolvin E1 in Chronic Periodontitis Patients

Context Under healthy conditions, inflammation proceeds through natural healing processes by an organized cycle. Similar to any other systemic infection, periodontal disease is also a manifestation of dysregulated inflammatory pathway.

Endogenous lipid mediators called resolvins and docosatrienes, produced from omega-3 fatty acid precursors, possess various immunoregulatory properties. These polyunsaturated fatty acids cannot be synthesized in body, instead these have to be taken through diet. This study aims to evaluate the effect of adjunctive treatment with daily dietary supplementation of omega-3 fatty acids in chronic periodontitis.

Aims The aim of this study was to assess periodontal parameters and salivary levels of Resolvin E1 with and without dietary supplementation of omega-3 fatty acid capsules in chronic periodontitis patients.

Methods and Materials Three-month comparative clinical study was performed on 52 patients allotted to two groups, each with 26 subjects. Both groups received an initial phase 1 therapy followed by additional dietary supplementation of 500 mg of omega-3 fatty acid capsules for 3 months for the test group. Salivary levels of Resolvin E1, periodontal parameters, including pocket probing depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and periodontal inflamed surface area (PISA), were assessed at baseline, 1 and 3 months after the study.

Statistical Analysis Used Data was analyzed with an unpaired t-test between the group and paired t-test for within the group comparison. p-Value less than 0.05 was considered significant.

Results PPD and CAL showed statistically significant differences between the two groups and within the groups

Salivary Metabolomics of Well and Poorly Controlled Type 1 and Type 2 Diabetes

Objective

The concentrations of endogenous metabolites in saliva can be altered based on the systemic condition of the hosts and may, in theory, serve as a reflection of systemic disease progression. Hemoglobin A1C is used clinically to measure long-term average glycemic control. The aim of the study was to demonstrate if there were differences in the salivary metabolic profiles between well and poorly controlled type 1 and type 2 subjects with diabetes. Subjects and Methods. Subjects with type 1 and type 2 diabetes were enrolled (n = 40). The subjects were assigned to phenotypic groups based on their current level of A1C: <7 = well-controlled and >7 = poorly controlled. Demographic data, age, gender, and ethnicity, were used to match the two phenotypic groups. Whole saliva samples were collected and immediately stored at -80°C. Samples were spiked using an isotopically labeled internal standard and analyzed by UPLC-TOF-MS using a Waters SYNAPT G2-Si mass spectrometer.

Results

Unsupervised principal components analysis (PCA) and orthogonal partial least squares regression discrimination analysis (OPLS-DA) were used to define unique metabolomic profiles associated with well and poorly controlled diabetes based on A1C levels.

Conclusion

OPLS-DA demonstrates good separation of well and poorly controlled in both type 1 and type 2 diabetes. This provides evidence for developing saliva-based monitoring tools for diabetes.

The New Era of Salivaomics in Dentistry: Frontiers and Facts in the Early Diagnosis and Prevention of Oral Diseases and Cancer

Nowadays, with the development of new and highly sensitive, blood is not the only medium of choice for the diagnosis of several diseases and pathological conditions. Saliva is now considered a safe and non-invasive sample to study oral and systemic diseases, showing great diagnostic potential. According to several recent studies, saliva has emerged as an emerging biofluid for the early diagnosis of several diseases, indicated as a mirror of oral and systemic health and a valuable source of clinically relevant information. Indeed, several studies have observed that saliva is useful for detecting and diagnosing malignant tumours, human immunodeficiency virus, heart disease, and autoimmune diseases. The growing realisation that saliva is an inexhaustible source of information has led to the coining of the term 'Salivaomics', which includes five "omics" in connection with the main constituents of saliva: genome and epigenome, transcriptomics, metabolomics, lipidomics, proteomics and microbiota. All those may be changed by disease state, so they offer significant advantages in the early diagnosis and prognosis of oral diseases. The aim of the present review isto update and highlight the new frontiers of salivaomics in diagnosing and managing oral disorders, such as periodontitis, premalignant disorders, and oral squamous cell carcinoma (OSCC).

Assessing salivary matrix metalloproteinase‐8 in prostate cancer patients undergoing androgen deprivation therapy

Introduction

Matrix metalloproteinase‐8 (MMP‐8) is considered as one of the most promising diagnostic markers for periodontal disease. Androgen deprivation therapy (ADT) has been correlated with impaired collagen synthesis and an increase in periodontal tissue susceptibility to pathogenic microorganisms.

Objective

This study aims to investigate the impact of ADT on salivary MMP‐8 level and periodontal parameters, which might be useful in monitoring periodontal disease in prostate cancer patients undergoing ADT.

Materials and Methods

A total of 88 subjects were selected and were divided into two groups: Group I included n = 78 PC patients who have been undergoing ADT); Group II included n = 10 healthy individuals. Periodontal parameters such as plaque index (PI), gingival index (GI), periodontal probing depth (PPD), and clinical attachment level (CAL) were examined. The salivary MMP‐8 level was estimated by using the sandwich enzyme‐linked immunosorbent assay method.

Results

Significant differences in mean salivary MMP‐8 level were found between PC patients undergoing ADT and healthy individuals. Salivary MMP‐8 levels of all individuals were positively correlated with GI, PI, PPD, and CAL. Salivary MMP‐8 can distinguish between periodontitis and healthy individuals with an accuracy of about 80%.

Conclusion

Salivary MMP‐8 levels were found to be higher in prostate cancer patients undergoing ADT compared to healthy individuals.

Implementing of aMMP‐8 point‐of‐care test with a modified new disease classification in Finnish adolescent cohorts

Objectives

Material and Methods

Results

Conclusions

Effect of Green Tea on the Level of Salivary Interleukin-1 Beta in Patients with Chronic Periodontitis: A Randomized Clinical Trial

Aim

Interleukin-1 beta (IL-1β) is one of the major biomarkers involved in the pathogenesis of chronic periodontitis. The aim of this study was to evaluate the changes in salivary IL-1β concentration in patients with chronic periodontitis following daily consumption of green tea.

Methods and Materials

Thirty patients with an average age of 45.8 years suffering from chronic periodontitis were randomly assigned into 2 groups (i.e., experimental and control groups). Besides receiving phase 1 periodontal treatment (scaling and root planning (SRP)), the experimental group drank green tea for a period of 6 weeks. To measure the concentration of salivary IL-1β, saliva samples were taken from both groups at 2 time points, i.e., prior to SRP (time point 1 (T0)) and after 6 weeks (time point 2 (T1)). The nonparametric Wilcoxon test was used to examine and compare the changes in the concentration of salivary IL-1β in each group relevant to the 2 time points (T0 and T1). Data were submitted to statistical analysis.

Results

At the end of the study period, a significant reduction (P=0.0001) in the concentration of salivary IL-1β was observed in the experimental group (A). As for the control group (B), however, there was no significant change (P=0.307) in the concentration of salivary IL-1β after 6 weeks following phase 1 periodontal treatment.

Conclusion

Green tea supplementation, in addition to SRP, may reduce salivary IL-1β levels in patients with chronic periodontitis for a period of 6 weeks.