Point-of-Care Salivary Testing for Poor Dental Health
Salivary point-of-care testing for periodontal disease is technically feasible but lacks validated clinical protocols and should not replace comprehensive dental examination with radiographs, which remains the standard of care for evaluating poor dental health. 1, 2
Current Evidence on Salivary Testing
The research demonstrates that while salivary biomarkers can detect periodontal disease, they are not yet ready for routine clinical implementation:
Promising biomarkers include MMP-8 (Metalloproteinase-8), IL-1β (Interleukin-1 beta), IL-6 (Interleukin-6), lactoferrin, hemoglobin, and leukocytes, which show significantly elevated levels in periodontitis patients compared to healthy controls 2, 3
Semi-quantitative strip tests measuring hemoglobin, leukocytes, and lactoferrin in saliva can distinguish between periodontitis and healthy patients, offering a rapid screening tool 2
Major limitation: The biggest hurdle is validation in large, diverse patient populations before these tests can be clinically implemented 1
Recommended Evaluation Strategy
Instead of relying on unvalidated salivary tests, perform a comprehensive dental assessment:
Complete periodontal examination including full-mouth plaque score, bleeding score, probing depth, clinical attachment level, bleeding on probing, recessions, mobility, and tooth migration 3
Radiographic evaluation with orthopantomography and intraoral radiographs to assess bone loss and detect dental pathology 4
Risk factor assessment for modifiable factors including periodontal disease stage III or greater, diabetes control, smoking status, and denture use 4
Management Algorithm Based on Findings
For patients with active periodontal disease:
Stage III or greater periodontal disease: Teeth meeting this criterion should be considered for extraction, particularly if radiation therapy or bisphosphonate therapy is planned 4
Conservative interventions first: Perform necessary dental extractions, conservative dental and periodontal treatments, and adjust prosthetics as needed 4
Patient education: Emphasize lifelong commitment to daily oral hygiene, maintenance of periodontal condition, and regular 6-month follow-up visits 4
For patients requiring cancer treatment:
Pre-treatment dental clearance: Complete dental examination must occur before initiating radiation therapy or bisphosphonate therapy, with at least 2 weeks healing time after extractions if oncologically safe 4
Coordinate care: Establish communication between oncology and dental teams, with patients seen by dentist within 2 weeks of referral 4
Clinical Pitfalls to Avoid
Do not delay necessary medical treatment for dental interventions when it could compromise oncologic control—radiation therapy should proceed even without ideal healing time if cancer treatment is urgent 4
Do not rely solely on salivary testing as current point-of-care tests lack the validation, standardization, and regulatory approval needed for definitive diagnosis 1, 5
Do not overlook modifiable risk factors including uncontrolled diabetes and smoking, which significantly increase risk of periodontal disease progression and complications 4
Future Potential
Lab-on-a-chip technology for chair-side salivary biomarker detection may eventually provide early diagnosis tools, but requires independent validation to ensure clinical accuracy, reliability, and consistency before implementation in patient care 5, 3