Saliva, Diagnostics, and Dentistry

Abstract

Saliva, a scientific and clinical entity familiar to every oral health researcher and dental practitioner, has emerged as a translational and clinical commodity that has reached national visibility at the National Institutes of Health and the President's Office of Science and Technology. "Detecting dozens of diseases in a sample of saliva" was issued by President Obama as one of the 14 Grand Challenges for biomedical research in the 21(st) Century (National Economic Council, 2010). In addition, NIH's 2011 Government Performance Report Act (GPRA) listed 10 initiatives in the high-risk long-term category (Collins, 2011). The mandate is to determine the efficacy of using salivary diagnostics to monitor health and diagnose at least one systemic disease by 2013. The stage is set for the scientific community to capture these national and global opportunities to advance and substantiate the scientific foundation of salivary diagnostics to meet these goals. A specific calling is to the oral, dental, and craniofacial health community. Three areas will be highlighted in this paper: the concept of high-impact diagnostics, the role of dentists in diagnostics, and, finally, an infrastructure currently being developed in the United Kingdom--The UK Biobank--which will have an impact on the translational and clinical utilizations of saliva.

Protein Biomarkers of Periodontitis in Saliva

“…If these aims are realised then this will greatly enhance not only the clinical care of periodontitis patients but also our ability to conduct more effective clinical and epidemiological studies of this common, complex disease. The integration of epidemiological studies of human health and disease with detailed biomarker analysis would help to determine marker sensitivity, specificity, and applicability; the UK Biobank [21] and National Health and Nutrition Examination Survey (NHANES) in the USA [186] are examples of resources that might be thus exploited.…”

“…There has been some considerable interest in promoting the dental clinic as a venue for general medical diagnosis through physiological measurements (such as weight, height, and blood pressure), finger stick blood tests, and salivary diagnostics [21]. For example, screening in the dental clinic for patients at risk of cardiac disorders is medically beneficial [186].…”

“…It is possible that different tests will be applicable to screening for disease susceptibility as compared to those required for monitoring of therapy and treatment selection [21]. Interestingly the power to predict differences between periodontal disease categories (moderate to severe periodontitis as compared to mild periodontitis and gingivitis) was increased when measures of salivary MMP-8 were combined with those of MMP-9, OPG, and calprotectin and quantification of periodontal pathogens such as P. gingivalis and Treponema denticola in dental plaque [82].…”

“…In combination, they promise to provide simultaneous and rapid measurement of multiple biomarkers coupled with data storage and transmission. Any novel technology must also have commercial attractiveness [21]. Technological developments aim to optimise biomarker measurement with respect to high sensitivity, high specificity, miniaturisation, high throughput, automation, portability, low cost, high functionality, measuring multiple disease markers, and simplicity of use.…”

“…The holy grail of biomarker research in periodontology is to develop a “high impact diagnostics” which have a significant impact on clinical decision making, patient outcomes, and healthcare economics [21] equivalent to existing clinical tests, such as prostate specific antigen testing, HIV viral load analysis, HbA1c, and cholesterol monitoring. Many studies of potential biomarkers in the periodontitis literature have historically focussed on analysis of gingival crevicular fluid (GCF) which is a serum transudate originating from the gingival blood vessels which lie close to the epithelial surface of the dentogingival junction, as reviewed elsewhere [22–24].…”