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A new study has unlocked the diagnostic power of saliva, and could change how gum disease—and a range of other oral health conditions—are detected and monitored in the future. By Shane Conroy
A groundbreaking new study may change the way dental practitioners think about saliva. The University of Queensland study has identified five potential saliva biomarkers that may be useful in diagnosing and monitoring treatment for gum disease.
The study’s findings could pave the way for the development of new saliva-based diagnostic tools for early gum disease detection and intervention.
Gum disease is often not diagnosed until visible symptoms appear, such as gum inflammation, bleeding, or receding gums. By the time these symptoms are noticeable, the disease may have already progressed significantly.
“Assessing salivary biomarkers could help dentists diagnose gum disease much earlier,” explains Dr Pingping Han, senior lecturer, School of Dentistry, Faculty of Health and Behavioural Sciences at the University of Queensland.
“It’s a silent disease, because it’s not really diagnosed until the dentists can see it. But biomarkers could make early intervention much more possible, which means dentists could start preventative treatment before the disease progresses.”
The study’s findings could also mark a significant step towards an industry-wide transition to precision dentistry.
Precision dentistry is an approach that tailors treatment to the individual characteristics of each patient. It takes into account factors such as genetics, environment, and lifestyle to create more effective and personalised treatment plans.
“Right now, most people go to the dentist every six months to get a check-up and a clean,” says Professor Sašo Ivanovski, head of school, School of Dentistry, Faculty of Health and Behavioural Sciences at the University of Queensland.
“But the reality is that some people need to be seen much more than that, and some people don’t need to be seen as often as that. Precision dentistry aims to identify patients’ individual profiles to provide more precise, predictive, and personalised dentistry.”
Why biomarkers?
Salivary biomarkers are measurable biological molecules found in saliva that can be used to monitor and diagnose various health conditions. Biomarkers are made up of proteins, genetic material, metabolites, electrolytes and bacteria, and may present a non-invasive alternative to blood testing for disease diagnosis and monitoring.
In dentistry, biomarkers may be particularly useful for diagnosing and monitoring oral diseases such as periodontal disease, dental caries, and oral cancer.
“We have been looking into the composition of saliva and whether any genes or proteins are specific to gum disease,” says Dr Han. “In this study, we discovered five potential biomarkers that are differentially expressed in healthy patients and patients with gum disease. That means our study confirms that saliva can be a potential diagnostic tool for gum disease.”
It also means that the use of biomarkers in dentistry could enhance the understanding of patient-specific conditions, and lead to more accurate diagnoses, better disease monitoring, and tailored treatment strategies.
We could potentially develop an at-home saliva diagnostic device so the patient could self-diagnose gum disease at home and even monitor their condition on an ongoing basis. Or the dentist could use a chair-side device to test for gum disease as part of a standard check-up.
Dr Pingping Han, senior lecturer, UQ School of Dentistry
“Assessing biomarkers that are associated with particular diseases will allow the dentist to understand what’s happening in that particular patient at any particular time. It’s all about diagnosing disease, monitoring disease, and understanding what may happen down the track,” Professor Ivanovski explains.
“For example, in particular patients, biomarkers might tell you that you need to see this patient more often, or treat this patient more aggressively. It’s a much more precise approach that’s tailored to the particular patient.”
The field of omics
Identifying gum disease may only be the tip of the iceberg when it comes to unlocking the full potential of saliva analysis in dentistry.
“What’s currently known is only a very small snippet of the whole story. We’re talking about thousands of potential molecules that are present in saliva, and the ability to detect these has not always been there,” says Professor Invanovski. “What we’re doing now is a really deep dive to find those proteins and molecules that might be the most accurate in identifying disease.”
Professor Ivanovski explains that new techniques in the field of omics are accelerating the understanding of salvia analysis.
Omics is a collective set of disciplines in biology that focus on the comprehensive study and analysis of various types of biological molecules, such as genes, proteins, and metabolites to understand their roles, relationships, and functions within an organism.
“This all essentially refers to understanding the gene profile of a person and the proteins present within a saliva sample,” Professor Ivanovski explains. “These are the things we’re using across a number of different studies to really understand firstly what can be detected in saliva, and how it’s related to the periodontal disease status of the patient.”
The future of diagnosis
The next step is validation. If the salivary biomarkers can be validated in follow-up studies, then work could potentially begin on the development of chair-side or at-home diagnostic devices.
“We could potentially develop an at-home saliva diagnostic device so the patient could self-diagnose gum disease at home and even monitor their condition on an ongoing basis,” says Dr Han. “Or the dentist could use a chair-side device to test for gum disease as part of a standard check-up.”
Another option could see patients sending saliva samples to a lab for testing, with notification of their gum disease risk profile and subsequent disease progression tracked via a mobile app. And if future studies can reveal salivary biomarkers for other oral conditions like dental caries and oral cancer, these too may one day be diagnosed and monitored with at-home or chair-side devices.
However, Professor Ivanovski believes we are still up to a decade away from seeing the widespread use of saliva diagnostic devices. But the implications are nonetheless transformative.
“It’s not outside the realm of possibility that we start to have some reasonably well-developed products within a five- to 10-year timeframe,” he says. “But the point is we’re understanding more and more about the role biology and genetics play in the susceptibility of the patient.
“This is just one example of how we are seeing a lot more medicine in dentistry than the mechanical approach to drilling and filling teeth.”
