Systemic Biomarkers for Periodontitis

Abstract

Periodontitis affects a subset of the population and our current thinking is that progression of periodontal disease may be either continuous or episodic. These features make diagnostic tools for disease status and progression assessment desirable in the management of this disease. Although many potential markers exist, several difficulties hamper our ability to declare them diagnostic tests with proven utility. The “gold standard” for active periodontal disease is not available, and the best indicators currently available include clinical measurements with low sensitivity and specificity that are also time consuming in their assessment and recording. Although much is written about the need for markers of current or future disease which will prevent us from overtreating pockets, the time, effort, and cost involved in testing these sites have to be balanced against the relative ease and speed of routine non-surgical periodontal therapy. In addition, we are still some way from the development and validation of reliable host factor/microbial factor testing methods. There are, however, multiple local and systemic periodontal diagnostic biomarkers proposed within the literature, although none is presently widely available commercially. One could envisage chairside tests using saliva or blood from finger sticks being capable to determine an individual’s risk of developing disease or a patient’s risk of disease progression and thus the need for a timely prevention program. In addition, blood drawn for routine diagnostic check-ups could also be used for the diagnosis and monitoring of periodontitis, if systemic biomarkers are identified. Before applying any test, we should reconsider what treatment planning effects a positive or negative result will have, since any test that does not influence the treatment plan is redundant. Systemic periodontal diagnostic tests are still at an early stage of development and much work remains to be performed to fully validate their utility such that they become an important and cost-effective aspect of clinical diagnosis, treatment planning, or patient monitoring. This paper provides a comprehensive review of systemic biomarkers derived form blood or saliva that have the potential to be utilized as a diagnostic and monitoring test for periodontitis at the patient level.