Diagnostic Models for Screening of Periodontitis with Inflammatory Mediators and Microbial Profiles in Saliva

Diagnostic performance of a point-of-care test device for periodontitis using human saliva: a single-center, single-blinded, confirmatory study

OBJECTIVE

Recently, matrix metalloproteinase-8 (MMP-8) has been used to diagnose periodontal disease in a point-of-care (POC) test in order to save time and cost relative to the traditional diagnostic workflow. This study aimed to investigate the diagnostic performance of INCLIX TRF MMP-8, a POC testing device for periodontitis using the area under the receiver operating characteristic curve, sensitivity, specificity, and predictive values.

MATERIALS AND METHODS

Full-mouth periodontal examination and radiographic analysis were used for evaluating periodontal condition based on the 2018 classification of periodontal disease. A dichotomous diagnosis of clinical periodontal condition was performed using the POC device. The relationships among periodontal condition and the concentration of MMP-8, tooth loss (TL), gingival index (GI), plaque index (PI), and alveolar bone loss (ABL) were assessed by the Spearman rank correlations (rs).

RESULTS

In all, 108 cases of non-periodontitis (NP) and 191 cases of periodontitis (P), including 38 cases of periodontitis stage I, 42 cases of periodontitis stage II, 99 cases of periodontitis stage III, and 11 cases of periodontitis stage IV, were enrolled in this study. Diagnostic accuracy in assessing periodontal condition with the POC device improved when it was used with participants aged ≥ 40 years. There were weak positive correlations between periodontal condition and MMP-8 and between periodontal condition and GI (rs2 = 0.1124 and rs2 = 0.0906, respectively), whereas a strong positive correlation between periodontal condition and alveolar bone loss (rs2 = 0.6877) was observed.

CONCLUSION

The POC device investigated in this study is a potential tool to distinguish between NP and P in individuals ≥ 40 years of age.

Comparative Evaluation of a Commercial Herbal Extract and 0.2% Chlorhexidine Mouthwash on Three Periodontal Facultative Anaerobes: An In Vitro Study

Background

The application of herbal and/or chemical antimicrobial mouthwashes in addition to the mechanical methods of bacteria removal helps reduce the periopathogens and thus increase the periodontal tissues' health. The present study aimed to evaluate the antibacterial effect of Thymex (TMX) syrup on three periodontal facultative anaerobes in vitro and compare it with 0.2% chlorhexidine (CHX) mouthwash.

Methods

In this in vitro experiment, the disc diffusion method was used to measure the inhibitory halo diameter (IhD) of Enterobacter cloacae, Actinomyces viscosus, and Eikenella corrodens. The paper discs containing TMX and CHX were placed on Mueller-Hinton agar media and cultured with the mentioned bacteria. Moreover, a blank disc containing distilled water was used as a control. From each of the three bacterial species, five samples were taken, and after 18 hours of storage in the incubator, the IhDs were measured in millimeters. A one-way ANOVA test and an independent sample t-test were used to compare the mean differences of IhDs between groups. The significance level was considered to be 0.05.

Results

The IhDs ranged between 6.2-8.8 mm and 12.3-34 mm for TMX and CHX, respectively. CHX showed a more inhibitory effect on all three species of bacteria compared to TMX mouthwash (P < 0.001).

Conclusions

Despite the inhibitory effect of TMX on bacterial growth, CHX showed significantly more antibacterial activity than TMX against three studied bacterial species.

The Role of Salivary C-Reactive Protein in Systemic and Oral Disorders: A Systematic Review

Background: Blood sampling is expensive, time-consuming, invasive, and requires technical facilities, which can be replaced by more convenient samples such as saliva. C-reactive protein (CRP) is a widely used biomarker in the management of many disorders and plasma CRP (pCRP) is suggested to be replaced by salivary CRP (sCRP). This study aimed to systematically review all available literature on the sCRP levels in systemic and oral disorders and how sCRP and pCRP levels correlate among these patients and healthy individuals. Methods: In this systematic review, a PubMed, Embase, Scopus, and Google Scholar search was conducted on October-2021 to identify all research investigating sCRP levels in systemic and oral disorders. Results: A total of 130 publications were analyzed in the review. Most of the studies reported that sCRP and pCRP levels are correlated, and sCRP is a reliable alternative for pCRP level for the diagnosis and management of medical conditions. sCRP has been measured in many different medical and oral disorders and significantly correlated with disease activity in most cases. Conclusion: Salivary CRP is a good alternative for Plasma CRP levels in most cases.

A Fresh Look at Mouthwashes-What Is Inside and What Is It For?

Mouthwashes are a very popular additional oral hygiene element and there are plenty of individual products, whose compositions are in a state of flux. The aim of our study was to investigate the compositions of mouthwashes and their functions, as well as to discuss their effectiveness in preventing and curing oral diseases and side effects. We searched for mouthwashes available on the market in Poland. We identified 241 individual mouthwash products. The extraction of compositions was performed and functions of the ingredients were assessed. Then, analysis was performed. The evaluation revealed that there are plenty of ingredients, but a typical mouthwash is a water–glycerine mixture and consists of additional sweetener, surfactant, preservative, and some colourant and flavouring agent, as well as usually having two oral health substances, anticaries sodium fluoride and antimicrobial essential oils. The effectiveness or side effects of several substances of mouthwashes were thoroughly discussed. We recommend not multiplying individual mouthwash products and their ingredients beyond medical or pharmaceutical necessity, especially without scientific proof.

Saliva as a Source of Biomarkers for Periodontitis and Periimplantitis

Saliva has the potential to be used as a diagnostic and monitoring tool for various diseases if biomarkers of an adequate sensitivity and specificity could be identified. Several reviews and even meta-analyses have been performed in recent years, which have found some candidate biomarkers for periodontitis, like macrophage inflammatory protein-1 alpha, interleukin-1ß, interleukin-6, matrix metalloproteinase-8, or hemoglobin. However, none of those are currently in use to replace conventional periodontal diagnostics with a periodontal probe. For periimplantitis, to date, heterogeneity of different study protocols and implant types did not permit to discover clear biomarkers, which were able to distinguish between healthy and diseased implants. Few proinflammatory cytokines, similar to periodontitis, have been characterized as adjunct tools to clinical diagnosis. The additional determination of antimicrobial peptides, bone turnover markers, and bacteria could help to enhance sensitivity and specificity in a combined model for periodontitis and periimplantitis. Furthermore, proteomic approaches might be preferred over single biomarker determinations. A global consensus is also needed to harmonize salivary sampling methods as well as procedures of biomarker analysis to ensure future comparability.