A REVIEW OF SALIVARY BIOMARKERS OF PERIODONTAL DISEASE

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D. Chukwuma¹. M. Arowojolu¹. J. Ankita²

1. Department of Periodontology and Community Dentistry, University College Hospital, Ibadan, Nigeria.
2. Chetna Dental Hospital and Research Center, Pradesh, India.

Abstract

Background: Periodontal disease is a complex multifactorial disease resulting from the interplay amongst microbiota, host immune response (influenced by genetic make-up) and lifestyle factors. The chronic inflammatory nature of the disease results in the destruction of the component of the periodontium. The process of the disease is associated with inflammation, collagen degradation and,N bone loss which correlate with clinical features of periodontal Ndisease. The clinical diagnosis of periodontal disease entails clinical examination involving the evaluation of probing depth, bleeding on probing, and radiographic examination of alveolar bone loss but these examinations are not enough to determine the activity, progression and, evaluation of the efficacy of the periodontal disease treatment. Given the foregoing gap in the traditional method of diagnosing periodontal disease, research on th molecular disease, biomarkers became imperative. The aim of this review is to summarize the current knowledge of salivary biomarkers of periodontal disease and to evaluate their validity in predicting disease progression.

Method: This narrative overview of 46 articles bordering on biomarkers of periodontal disease was conducted between 2000 to 2023, and assessed in Google Scholars, PubMed/Medline, Science Direct Database using keyword combined with Boolean operators. This was done following literature search; articles title, abstract evaluation and full-text reading studies.

Results: The present review comprised of 46 studies were included (observational studies; reviews articles; and experimental studies), focusing on the detection of periodontal disease using non-traditional method; saliva as a medium for detection of periodontal disease biomarkers.

Conclusion: Saliva is considered as a non-invasive and easier to collect medium for the detection of biomarkers as it contains virtually all the molecules found in other diagnostic media; serum and blood. This review highlights recent advances in salivary biomarkers as proteomics, genomics, and microbial biomarkers and potential clinical applications as well as available Point of Care (POC) diagnostics that aid easy diagnosis and prognosis.

Keywords: Biomarkers, Saliva, Periodontal disease

Introduction

Periodontal disease is a chronic microbial and inflammatory process characterized by the presence of pathogenic bacteria, impaired host immune response, and destruction of the components of the periodontium. In affected tissues, biochemical signaling involves three biological phases (inflammation, connective tissue degradation, and alveolar bone turnover). Periodontitis is a public health issue and one of the six complications of diabetes worldwide, with an overall prevalence of 11.2% and affecting around 743 million individuals. There has been an increase in periodontal disease globally of 57.3% from 1990 to 2010.

Epidemiological studies have shown that the highest prevalence of periodontitis is in elderly populations (82%), followed by other adults (73%) and adolescents (59%).On the other hand, paucity of epidemiological data on epidemiology of periodontal diseases in Africa persist. People in lower socio-economic groups are unequally affected by periodontal disease.

Research emanating from the World Health Organization showed that children and teenagers experience gingivitis, a form of periodontal disease unlike severe periodontitis in adults persons of about 5-20%.2 The relationship of periodontitis to certain systemic disease such as diabetes, atherosclerosis, cancers, and Alzheimer has been proffered; as the effect of periodontitis is not limited to the periodontium. On account of the slow and innocuous progression of periodontal disease its harmful effect to the periodontal ligament, cementum, alveolar bone and gingiva can result in tooth loss and its associated effects on the quality of life of the patient. Early diagnosis of gingivitis may prevent its progression to periodontitis following treatment.1

Innate immunity helps to maintain oral health through physiological barriers (skin and mucous membranes) and other mechanisms (polymorphonuclear leukocyte surveillance and physiologic immune surveillance) through the toll like receptors, dendritic cells, macrophages, PMN cells, NK cells, complement system and cytokines. The numerous salivary defense mechanisms include locally and systemically produced cytokines, immunoglobulins, lysozymes, mucins, and an array of antimicrobial proteins(AMP); which serve as major components of the innate defense mechanism Circulating molecules such as interleukin (IL)-1â, Creactive proteins, human macrophage inflammatory protein (MIP)-1á, matrix metalloproteinase (MMP)-8 and -9, osteoprotegerin (OPG), tumor necrosis factor (TNF)-á, receptor activator of nuclear factor-kappa B ligand (RANKL), and many others are somewhat elevated in the whole saliva of periodontitis patients, thus making them supposed biomarkers of the disease.3,4,5

Traditionally, periodontal diagnostic methods include assessment of clinical parameters and radiographs. The application of the clinical method in diagnostic though beneficial and reliable is froth with being expensive concerning time, cost, and professional expertise required. But with advanced diagnostic method using serum and salivary molecules periodontal diseases is relatively easily diagnosed.