The clinical value of salivary biomarkers for periodontal disease.


Periodontal disease is a chronic bacterial infection characterized by persistent inflammation, connective tissue breakdown, and alveolar bone destruction (3). It has been a great challenge in periodontology to determine biomarkers for screening and predicting the early onset of disease (prognostic tests) or evaluating the disease activity and the efficacy of therapy (diagnostic tests). Traditional diagnostic measures, such as periodontal pocket depth, attachment level, plaque index, bleeding on probing and radiographic assessment of alveolar bone loss, are informative to evaluate disease severity (83) but provide few useful determinants of disease activity (2, 29, 30, 61, 80). The presence of bleeding on probing is still the best disease activity predictor available, but it is not specific enough and thus reveals too many false positives. The absence of bleeding on probing on the other hand is a very precise negative predictor of disease activity (59, 60, 73). The identification of susceptible individuals or sites at risk from disease, and the diagnosis of active phases of periodontal disease, represent a challenge for both clinicians and oral health researchers. Indeed, the subjectivity and variability of definitions of the periodontitis phenotype in clinical studies are such that no universally accepted diagnostic criteria exist to define what a case of periodontitis is, thus making outcomes from different studies difficult to compare (11). It has long been established that a simple and non-invasive diagnostic tool that allows rapid screening, provides accurate predictive information and enables reliable evaluation of periodontal disease status would be of great value to both dentists and patients. Saliva is a secretion of the salivary and mucous glands and is of major importance in the maintenance of oral health (22). The fluid is readily accessible via a totally non-invasive collection method, and contains locally produced microbial and host response mediators. For the past two decades, saliva has been increasingly evaluated as a diagnostic fluid for detecting caries risk (12, 13, 62), periodontitis (18), oral cancer (63), breast cancer (104–107), salivary gland diseases (42) and systemic disorders such as hepatitis and the presence of human immunodeficiency virus (HIV) or hepatitis C virus (23, 39, 75, 123). The ease of collecting, handling and testing saliva has led to its use for determining hormone levels, including estradiol, progesterone and testosterone, dehydroepiandrosterone and cortisol (31). Numerous drugs are detectible in oral fluid, and can even be quantified in saliva as a viable substitute for testing in blood, and, as a result, salivary diagnostic technology is currently utilized to test for drugs of abuse, such as cocaine (50, 94), methamphetamines (44, 93) and opiates (20). Additionally, testing of saliva can also be used for therapeutic monitoring of drugs, such as digoxin (19, 108), methadone (17) and some anticonvulsants (34). The biochemical analysis of saliva is particularly important in dentistry. Estimation of the risk of disease onset and severity, monitoring of disease progression and evaluation of therapeutic efficacy for premalignant and malignant oropharyngeal lesions as well as infectious diseases of the oral cavity can be performed by analyzing an array of constituents within saliva. Although there is a large body of literature on gingival crevicular fluid biomarkers, this review limits itself to saliva analysis. Salivary constituents that have been studied as potential diagnostic biomarkers for periodontal disease mainly include locally produced proteins of host and bacterial origin (enzymes, immunoglobulins and cytokines), genetic ⁄ genomic biomarkers such as DNA and

DOI: 10.1111/j.1600-0757.2009.00315.x
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@article{Zhang2009TheCV, title={The clinical value of salivary biomarkers for periodontal disease.}, author={Lei Zhang and Bradley Stephen Henson and Paulo Ant{\^o}nio Monteiro Camargo and David T. Wong}, journal={Periodontology 2000}, year={2009}, volume={51}, pages={25-37} }