Dental implants are the ultimate service in dentistry. It can be life changing for patients and satisfying for the dentist. The success rate is high but for some there are failures and in that group the cause is not easily found. 

Saliva is an integral part of dental and overall health and wellness. From cleaning the mouth, neutralizing mouth acid, aiding in digestion to keeping the teeth strong. A simple saliva test can let the clinician know different kinds and levels of bacteria that clearly show markers of the body’s tolerance to the attacking bacteria. Salivary diagnostics offer a modern approach known as minimal intervention that focuses on identifying potential dental and medical conditions from caries to diabetes.

Did you know that the second leading cause of cardiovascular incidents and stroke is periodontal disease? In some patients their oral health could predict how they would handle disease and how their bodies would respond to the proper corrective treatment modalities. Salivary tests can show how the patient’s body will handle inflammation and their threshold levels and how they can tolerate offending genetic markers.

When a clinician can identify the cause of periodontal disease, the specific pathogens in a patient's mouth, treatment planning and risk assessments are facilitated using hard data rather than a subjective assessment protocol. Odd as it may seem poor oral hygiene in and of itself cannot cause periodontal disease nor can smoking, diabetes, or xerostomia. All of those factors increased the likelihood of periodontal developments but they are not direct causes. The causative agents in the case of periodontal disease are specific bacteria. But development appeared on histories require specific or bacteria plus the patient’s immune-inflammatory response in a genetically susceptible individual.

The most widely used tests are for 11 pathogens that are known to contribute to periodontal destruction. In addition to bacterial profile testing there are tests to tell us a patient’s genetic predisposition toward inflammation. Of course, a genetic profile can't be changed but the knowledge if a person that has overactive inflammatory response helps the practitioner in treatment, the frequency needed for their continuing care and adjunct therapies. 

Some of the high-risk pathogenic bacteria such as Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), and Treponema denticola (Td) are highly toxic bugs associated with aggressive forms of periodontal disease. A salivary test report will specifically state which antibiotics are indicated for that bacteria profile. Taking the guesswork out of what to prescribe. High-risk bacteria in a periodontally healthy person or in someone with gingivitis elevates their risk of the future in disease development. We almost having the ability to look into the future.

If a bacterial tests reveals the presence of Fusobacterium nucleatum (Fn), Pg and/or Aggregatibacter actinomycetemcomitans (Aa), in addition to Tf and Td, there may be other issues to help the patient with because these bacteria have been identified as directly causative for atherosclerosis development.

Candida can also be identified on a salivary test and is important when choosing a treatment. Some types of candida are resistant to standard anti-fungal treatments, so identifying the species is key to the how to proceed with treatment.

There are currently chairside tests for: ¹

• The evaluation of the number and concentration of bacteria implicated in periodontitis
• Detect CD44 and total protein associated with oral cancer
• Detect HIV-1 and/or HIV-2 antibodies in oral fluid
• Evaluate genetic markers related to inflammatory response
• Detect drug metabolizer status
• Detect genetic polymorphisms associated with increased genetic risk for severe periodontal disease
• Screening tool to identify type(s) of oral HPV present
• Detect and identify all common species of Candida present in the oral cavity
• Detect increased levels of certain mRNA's associated with increased risk of oral cancer

Taking a salivary sample is quick and easy. Paper point collecting devices are put into the sulcus for a few seconds then the points are collected and sent in a prepackaged container and sent back to a lab. With this technique you have an opportunity to just test in a specific site, for example an implant, that has begun to develop peri-mucositis. After the data is sent back you can then treat the area with a customized treatment, not a one size fits all approach. Other salivary diagnostics require a patient to rinse for 30 seconds followed by spitting into a funnel-equipped collection tube. The funnel is removed, the tube is capped, and the sample is sent to a lab using the provided shipping materials.

The diagnostic applications of saliva reach far past dental treatment.  According to a new study conducted by the ADA Health Policy Resources Center (HPRC), screenings by dentists for the most common chronic medical diseases could save the American health-care system as much as $102.6 million annually, while providing healthier patient outcomes. Salivary diagnostic testing will be the means to this end.

Being informed prior to implant placement can make a difference in the success of treatment. The more we understand about a patients bacterial load can help both the patient but  giving optimal care that can only elevate the value of the dental practice.

1. Salivary Diagnostics. Salivary/Oral Fluid Diagnostics. American Dental Association. 18 Aug. 2018. Retrieved from www.ada.org/en/member-center/oral-health-topics/salivary-diagnostics.