Salivary Levels of Hemoglobin for Screening Periodontal Disease: A Systematic Review

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.

Diagnostic accuracy of salivary hemoglobin, lactate dehydrogenase and Interleukin-6 to determine chronic periodontitis and tooth loss in type 2 diabetics

Background

Salivary Hemoglobin (SH) has emerged as the mainstay non-invasive and a practicable screening method for Chronic Periodontitis. Current research aims to comprehensively assess the diagnostic value of Salivary Hb (SH) in comparison with Salivary IL-6 (SIL-6) and levels of Salivary lactate dehydrogenase enzyme (SLDH) amongst Type II Diabetes subjects having Chronic Periodontitis (CP) and associated tooth loss.

Materials and methods

In this cross-sectional comparative investigation, 240 individuals with at least 15 remaining teeth, ranging in age from 30 to 70, were chosen and Group I controls were defined as follows: healthy (HbA1c levels ≤6.4 %) with no CP; Group II included chronic periodontitis and non-T2DM (HbA1c ≤ 6.4 %); Group III included T2DM (HbA1c ≥ 6.5 %) and CP; and Group IV included T2DM (HbA1c ≥ 6.5 %) with periodontitis-related tooth loss. ELISA colorimetric assay was used to quantify the results using the unstimulated whole saliva of fasting participants. Tukey's post hoc test was used for statistical analysis following Analysis of Variance (ANOVA), and Sensitivity and Specificity were computed following the determination of the correlation coefficient.

Results

One-way ANOVA comparing Biomarker levels across the four groups revealed a statistically significant difference (F = 68.013) (p = 0.0001). Tukey's multiple post hoc yielded a significant difference between groups with least mean average biomarker levels observed among the controls (Group1) and maximum with group IV. Diagnostic Accuracy to discriminate between CP in T2DM & Controls with SH surpassed that of SIL-6 & SLDH, Receiver operating characteristic (ROC) curve depicted an overall sensitivity of 67.62 %, specificity of 80 % and accuracy of 74 % in T2DM subjects with tooth loss for the identification and assessment of CP.

Conclusion

Estimates of Salivary Hemoglobin can assume an important role in comparison to SIL-6 & SLDH in determining the degree of periodontitis, including tooth loss, and identifying elevated glycemic levels. Advanced detection and monitoring can be ensured by routine use in dental offices and general practice.

Comparative analysis of serum and saliva samples using Raman spectroscopy: a high-throughput investigation in patients with polycystic ovary syndrome and periodontitis

BACKGROUND

Polycystic ovary syndrome (PCOS) and periodontitis significantly affect women's oral and systemic health worldwide, and yet increase the risk of cardiovascular-metabolic diseases like diabetes and coronary heart disease. Regarding the PCOS-periodontitis connection, whether sex hormones, metabolic and inflammatory mediators could account for the underlying linking mechanism needs to be further investigated. This case-control study evaluated the hormonal, metabolic and inflammatory profiles in PCOS and non-PCOS subjects with various periodontal conditions, via assessing serum and saliva samples by Raman spectroscopy.

METHODS

A total of 66 females with PCOS and 22 systemically healthy female volunteers were recruited in a single hospital. Full-mouth periodontal examination was undertaken for identifying the subjects with periodontal health, gingivitis or periodontitis. The datasets of sex hormones and metabolic indicators were retrieved from the hospital information system. Both serum and saliva samples were collected for detecting inflammatory mediators and Raman spectroscopic assessment. The subjects were categorized into four groups according to their conditions of PCOS and periodontitis for Raman spectroscopic analysis. Partial least squares discriminant analysis was performed to examine the inter-group differences in Raman spectra.

RESULTS

PCOS patients exhibited greater mean probing depth (P < 0.05) and higher serum levels of triglycerides (P < 0.05) and matrix metalloproteinase-8 (P < 0.05) than those in non-PCOS participants. Both probing depth and triglyceride level were positively correlated with PCOS (P < 0.05). There was a significant difference in mean Raman spectra of saliva samples among the four groups with different conditions of PCOS and periodontitis (P < 0.05), while no significant inter-group difference existed in serum samples.

CONCLUSIONS

The present study shows that periodontal condition may affect the biomolecular profiles of Raman spectra in serum and saliva of PCOS patients. It underscores the importance of the collaborative teamwork of dentists and gynecologists for enhancing women's oral health, general wellbeing and quality of life.

Relationship between Masticatory Function and Bone Mineral Density in Community-Dwelling Elderly: A Cross-Sectional Study

The relationship between masticatory function and bone mineral density (BMD) is unclear. This cross-sectional study examined this relationship after adjusting for confounding factors. The subjects were 702 community-dwelling elderly adults (306 men, 396 women) who had been recruited for the Community-Based Healthcare Research and Education study in 2019. Objective masticatory function was assessed using the gummy jelly method. The median for each descriptive statistic was 69.0 years for age, 86.2% for the young adult mean, and 18.0 for masticatory function. Comparisons of the groups with good and poor masticatory function by sex revealed a significant difference in muscle mass and the tooth number for both sexes (p < 0.05). Men showed significant differences in age (p < 0.05) and salivary occult blood findings (p < 0.05). Multivariate analysis using propensity scores showed a significant association between masticatory function and BMD in both sexes (men: odds ratio 163.0, 95% confidence interval 1.36–19,610.55, p = 0.04; women: odds ratio 48.65, 95% confidence interval 1.52–1561.15, p = 0.03 in women). Masticatory function and BMD in the community-dwelling elderly may be related. However, other factors, including frailty and sarcopenia, may also be involved. Regular oral health care by dentists and dental hygienists may benefit this population.

Oral Diagnostic Methods for the Detection of Periodontal Disease

Periodontitis is a common immune-inflammatory oral disease. Early detection plays an important role in its prevention and progression. Saliva is a reliable medium that mirrors periodontal health and is easily obtainable for identifying periodontal biomarkers in point-of-care diagnostics. The aim of this study is to evaluate the effectiveness of diagnostic salivary tests to determine periodontal status. Whole saliva (stimulated/unstimulated) from twenty healthy and twenty stage III grade B generalized periodontitis patients was tested for lactoferrin, alkaline phosphatase, calcium, density, osmolarity, pH, phosphate, buffer capacity, salivary flow rate and dynamic viscosity. A semi-quantitative urinary strip test was used to evaluate markers of inflammation in saliva (erythrocytes, leukocytes, urobilinogen, nitrite, glucose, bilirubin, and ketones), clinical periodontal parameters and pathogenic bacteria. Concentrations of lactoferrin, hemoglobin, and leukocytes were found to be significantly higher in the stimulated and unstimulated saliva in periodontitis patients compared to healthy patients, whereas alkaline phosphatase levels were higher in unstimulated saliva of periodontitis patients (p < 0.05). Periodontal biomarker analysis using test strips may be considered rapid and easy tool for distinguishing between periodontitis and healthy patients. The increase in lactoferrin, hemoglobin, and leucocytes-determined by strip tests-may provide a non-invasive method of periodontal diagnosis.

Accuracy of a salivary examination kit for the screening of periodontal disease in a group medical check-up (Japanese-specific health check-up)

The purpose of the present study was to investigate the accuracy of a screening method using salivary tests to screen for periodontal disease.In total, 1888 individuals older than 30 years in 2017 and 2296 in 2018 who underwent medical check-ups for metabolic syndrome agreed to participate and simultaneously underwent a dental examination by dentists and salivary tests. Salivary occult blood, protein, and ammonia levels and white blood cell counts were evaluated in salivary tests using commercially available kits. The relationship between the results of the salivary tests and dental examination was examined and classification performance was analyzed.The prevalence of periodontal disease was 69.9% in 2017 and 66.8% in 2018. Salivary ammonia showed the highest classification performance in both years (sensitivity 83.5 and 83.1%, precision 73.0 and 69.3%, F-measure 0.779 and 0.756). Occult blood, which was assessed using a monoclonal antibody to human hemoglobin, also showed good performance (sensitivity 69.5%, precision 70.6%, F-measure 0.701). Questions regarding self-reported gingival bleeding were not sufficient to screen for periodontitis. The present results suggest that screening tests using salivary samples may detect periodontal disease in approximately 70% to 80% of subjects in a large population.Conclusion: Salivary ammonia and hemoglobin have potential as salivary markers in the screening of periodontal disease.

Optimal Examination Sites for Periodontal Disease Evaluation: Applying the Item Response Theory Graded Response Model

Periodontal examination data have a complex structure. For epidemiological studies, mass screenings, and public health use, a simple index that represents the periodontal condition is necessary. Periodontal indices for partial examination of selected teeth have been developed. However, the selected teeth vary between indices, and a justification for the selection of examination teeth has not been presented. We applied a graded response model based on the item response theory to select optimal examination teeth and sites that represent periodontal conditions. Data were obtained from 254 patients who participated in a multicenter follow-up study. Baseline data were obtained from initial follow-up. Optimal examination sites were selected using item information calculated by graded response modeling. Twelve sites—maxillary 2nd premolar (palatal-medial), 1st premolar (palatal-distal), canine (palatal-medial), lateral incisor (palatal-central), central incisor (palatal-distal) and mandibular 1st premolar (lingual, medial)—were selected. Mean values for clinical attachment level, probing pocket depth, and bleeding on probing by full mouth examinations were used for objective variables. Measuring the clinical parameters of these sites can predict the results of full mouth examination. For calculating the periodontal index by partial oral examination, a justification for the selection of examination sites is essential. This study presents an evidence-based partial examination methodology and its modeling.

Novel oral biomarkers predicting oral malodor

OBJECTIVE

We sought new markers to predict oral malodor.

STUDY DESIGN

Seventy-five adults complaining of oral malodor were classified into 3 groups clinically: no oral malodor, physiologic oral malodor, and periodontitis-derived oral malodor. In addition to conventional clinical parameters, 7 salivary components, occlusal force, and lip-closing force were compared among the groups.

RESULTS

Concerning the salivary components, cariogenic bacteria, occult blood, leukocytes, and ammonia differed significantly among the groups. Multiple logistic regression analyses indicated that tongue-coating scores and ammonia levels were significantly associated with genuine oral malodor, including physiologic oral malodor and periodontitis-derived oral malodor, and the tongue-coating score, plaque index, and occult blood level were significantly associated with periodontitis-derived oral malodor. Occlusal force and lip-closing force did not differ among the groups. However, there was a statistically significant interaction between occlusal force and lip-closing force in oral malodor in women (P = .019).

CONCLUSIONS

Novel salivary markers, ammonia levels, and occult blood levels may predict genuine oral malodor and periodontitis-derived oral malodor, respectively. An interaction effect between occlusal force and lip-closing force on oral malodor was identified in women.

Cross-sectional study of age-specific differences in salivary occult blood test results in older adults

This study aimed to identify factors associated with poor oral health status, as indicated by salivary occult blood (SOB) level, in community-dwelling older adults. A total of 592 community-dwelling participants aged 70 to 84 years with 20 to 28 teeth participated in the survey and SOB evaluation. Survey items included behaviors during dental visits, systemic diseases, smoking habit, cognitive function, and findings of intraoral examination. To identify factors associated with high SOB levels, binomial logistic regression analysis was performed after classifying participants as having high and low SOB on the basis of 75th-percentile SOB measurements. Presence of dental plaque (odds ratio [OR]: 2.26), poor subjective oral health (OR: 2.99) (for the age group 70 to 74 years), fewer remaining teeth (OR: 0.80), no dental visits during the previous year (OR: 2.80) (for the age group 75 to 79 years), and no dental visits during the previous year (OR: 3.93) (for the age group 80 to 84 years) were significantly associated with high SOB levels. The factors associated with high SOB, which indicates poor oral health status, differed by age group in community-dwelling older adults. Therefore, oral health management may improve oral health by providing different age groups with care that accounts for their physical and social functional abilities.

ICP-Mass-Spectrometry Ionic Profile of Whole Saliva in Patients with Untreated and Treated Periodontitis

Over the past decade, there has been growing interest in the association between macro and trace minerals in body fluids and systemic diseases related to chronic inflammation and oxidative stress. Due to the paucity of data in the literature on periodontitis, the aim of this cross-sectional study was to assess the relationship between mineral elements in saliva and periodontal status in patients with untreated and treated periodontitis compared to periodontally healthy controls. Salivary samples from 66 nonsmoker healthy patients (20 periodontally healthy, 24 untreated severe periodontitis and 22 treated severe periodontitis) were analyzed by using inductively coupled plasma mass-spectrometry (ICP-MS). Significant increases in copper (Cu), sodium (Na), iron (Fe) and manganese (Mn) concentrations occurred in saliva of severe periodontitis subjects compared to periodontally healthy controls. No differences were detected between healthy controls and treated periodontitis patients apart from levels of zinc (Zn) and lithium (Li) that were found to be increased and reduced, respectively, in periodontitis group. Most subjects were correctly separated by cluster analysis into active periodontitis and periodontally healthy individuals. Treated periodontitis individuals were classified as healthy subjects. Based on these preliminary results, the assessment of salivary concentration of mineral elements might be useful in discriminating periodontal health and disease.

Detection of hepatocyte growth factor in oral rinses using water for possible periodontal diagnosis

The aim of this study is to analyze the relationship between Hepatocyte Growth Factor (HGF) levels in oral rinses using water and clinical parameters of periodontitis; and furthermore, to evaluate the potential of a prototype HGF immunochromatographic paper test strip (HGF-TS) for screening of periodontitis, in comparison with a commercially-available occult blood (hemoglobin) test strip (Hb-TS). Clinical periodontal parameters were recorded, and oral rinses were collected, from 125 subjects. Then, the presence of HGF, and hemoglobin (Hb), in each sample was detected using a prototype HGF-TS and an Hb-TS. In addition, the concentrations of HGF and Hb were also determined in each sample is necessary HGF concentrations in oral rinses showed significant correlations with clinical parameters of periodontitis. The positive rate and read value on HGF-TS showed significantly high values in cases of severe periodontitis compared to healthy subjects. Hb-TS showed generally higher positive rates than HGF-TS; however, it showed false positive results in healthy subjects. The concentration of HGF in oral rinses showed close association with the severity of periodontitis, suggesting that the prototype HGF-TS has potential for use in the diagnosis of periodontitis, although further refinement of the test strip is required to increase the sensitivity.