Diagnostic accuracy of a point‐of‐care aMMP‐8 test in the discrimination of periodontal health and disease

Abstract

Aim: To assess the diagnostic utility of an oral rinse active matrix metalloproteinase-8 (aMMP-8) point-of-care test (POCT) for differentiating periodontal health, gingivitis, as well as different stages and grades of periodontitis. Materials & Methods:The aMMP-8 index test was undertaken in 408 consecutive adults, followed by a full-mouth periodontal examination. The reference standard was the 2017 World Workshop classification of periodontal diseases. Sensitivity, specificity, and the area under the receiver operating characteristic curve (AUROC) were assessed.Results: 68.6% of the participants were diagnosed with periodontitis, including Stages I (15.9%), II (15.9%), III (29.7%) and IV (7.1%). A positive aMMP-8 POCT was associated with periodontitis after adjusting for age, gender, tobacco smoking and systemic diseases, while it was unable to differentiate among the stages/grades of periodontitis and between gingivitis/periodontal health. This test showed a sensitivity of 33.2% and a specificity of 93.0% for detecting periodontitis (threshold level >10 ng/ml). The levels of aMMP-8 adjusted by the number of teeth present (aMMP-8/NTP) performed better for periodontitis (sensitivity: 67.1%; specificity: 68.8%). Notably, aMMP-8/NTP were strongly predictive for Stage IV periodontitis (threshold level =0.4312 ng/ml) (sensitivity: 89.7%; specificity: 73.6%; and AUROC: 0.856). The test performance greatly improved in combination with age and smoking, with a sensitivity of 82.5%, a specificity of 84.4%, and an AUROC of 0.883. Conclusion:This aMMP-8 POCT is able to detect periodontitis with better specificity than sensitivity across the spectrum of its severity. This test may be useful for periodontal screening in conjunction with subject characteristics and/or other sensitive screening tools. Further validation studies are needed. K E Y W O R D Sdiagnosis, gingivitis, matrix metalloproteinase-8, periodontal health, periodontitis, point-ofcare test, screening, sensitivity and specificity Clinical RelevanceScientific rationale for the study: The traditional periodontal diagnostic approach relies on clinical parameters that are difficult to measure, lack precision to detect incipient periodontitis and can only reflect the previous tissue destruction. Point-of-care biomarker tests based on oral fluidsThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

On the accuracy, sensitivity, and grading of mouthrinse active matrix metalloproteinase‐8 (aMMP‐8) point‐of‐care testing (POCT)

“…In light of these outcomes and their ensuing differences, we agree with Deng et al (2021) that additional studies with aMMP-8…”

“…In the exclusion criteria, Deng et al (2021) state that patients who had received supportive periodontal treatment (supragingival cleaning) were not excluded from their study. That may have improved the oral health of patients in both healthy/gingivitis and periodontitis groups, which consequently might have affected the aMMP-8 POCT results by Deng et al (2021). Additionally, Sorsa, Alassiri, et al (2020) used aMMP-8 POCT with 20 ng/ml in their study, whereas Deng et al (2021) used 10 ng/ml as the cut-off.…”

“…That may have improved the oral health of patients in both healthy/gingivitis and periodontitis groups, which consequently might have affected the aMMP-8 POCT results by Deng et al (2021). Additionally, Sorsa, Alassiri, et al (2020) used aMMP-8 POCT with 20 ng/ml in their study, whereas Deng et al (2021) used 10 ng/ml as the cut-off. According to the manufacturer, such dipsticks with a 10 ng/ml cut-off for aMMP-8 have not been marketed.…”

“…For example, patients under supportive periodontal/peri-implant therapy and maintenance, thus dubbed to have their periodontal/peri-implant disease "under control", have been repeatedly demonstrated to have lower oral fluid aMMP-8 levels, BOP, and PPDs (Ziebolz et al, 2017;Schmalz et al, 2018). Thus, periodontally "healthier" samples with low T A B L E 1 Comparison of number of teeth, bleeding on probing (BOP) and periodontal probing depth (PPD) of HK (Hong Kong, Deng et al, 2021) and G (Greece, Sorsa, Alassiri, et al, 2020) aMMP-8 levels, reflecting lower PPDs and BOP in the HK sample, eventually explain the decrease in the sensitivity of aMMP-8 POCT and correspondingly high specificity as reported by Deng et al (2021). With the probability of active disease being lower in the presence of diligent periodontal maintenance, these patients would naturally report lower or negative aMMP-8 POCT results.…”

Authors' Response: “Diagnostic accuracy of a point‐of‐care aMMP‐8 test in the discrimination of periodontal health and disease”

“…Since a large portion of our population had aMMP-8 values below 10 ng/ml (undetectable levels), we performed and reported analyses with different cut-off values (Deng et al, 2021a). Data showed that raising the cut-off value for a positive test from 10 to 20 ng/ml resulted in a decrease in sensitivity (from 33.2% to 17.5%).…”