The development of commercial laboratory tests utilizing the collection of saliva is, in my opinion, an important step forward in understanding and managing inflammatory periodontal disease. There are, in fact, no tests available that will predict the onset of attachment loss. However, by gathering information on a patient’s genetic inflammatory profile as well as periodontal pathogen profile we have access to objective data when ascertaining risk, or the possible onset of periodontal disease activity.
Determining the risk is especially significant in patients with some compromise of their immune function (i.e. diabetics, smokers, etc.). While the genetic testing provides insight into the patient’s cytokine producing risk, the pathogen profiling gives insight into the pathogenesis and total bacterial burden of the infection. The presence of inflammatory stimuli in combination with elevated levels of certain pathogen groups in a patient with elevated inflammation genetic markers puts the patient at increased risk for an excessive inflammatory response. Looking at the underlying biology can be helpful in, not only predicting risk, but altering the treatment approach and determining monitoring intervals for management.
With time, there will be many additional proof of concept studies. But the good news is that we don’t have to wait. We clearly have available today testing tools to help determine risk and help drive better treatment outcomes.