An aMMP-8 Point-of-Care and Questionnaire Based Real-Time Diagnostic Toolkit for Medical Practitioners.

Ismo T Räisänen,Hanna Seppänen,Andreas Grigoriadis,Vaibhav Sahni,Taina Tervahartiala,Hanna Lähteenmäki,Dimitra Sakellari,Timo Sorsa,Juho Suojanen,Shipra Gupta

doi:10.3390/diagnostics11040711

Abstract

The aim of this cross-sectional study is to propose an efficient strategy based on biomarkers adjunct with an interview/questionnaire covering risk factors for periodontitis for the identification of undiagnosed periodontitis by medical professionals. Active matrix metalloproteinase (aMMP)-8 levels in mouthrinse were analyzed by a point-of-care (PoC)/chairside lateral-flow immunotest, and salivary total MMP-8, total MMP-9 and calprotectin levels were analyzed by enzyme-linked immunosorbent assays (ELISAs) and active MMP-9 by gelatin zymography for 149 Greek patients. Patients underwent a full-mouth oral health examination for diagnosis according to the 2018 classification system of periodontal diseases. In addition, patient characteristics (risk factors: age, gender, education level, smoking and body mass index) were recorded. Receiver operating curve (ROC) analysis indicated better diagnostic precision to identify undiagnosed periodontitis for oral fluid biomarkers in adjunct with an interview/questionnaire compared with a plain questionnaire (i.e., risk factors): aMMP-8 AUC (95% confidence interval) = 0.834 (0.761−0.906), total MMP-8 = 0.800 (0.722–0.878), active MMP-9 = 0.787 (0.704–0.870), total MMP-9 = 0.773 (0.687−0.858) and calprotectin = 0.773 (0.687–0.858) vs. questionnaire = 0.764 (0.676–0.851). The findings of this study suggest that oral fluid biomarker analysis, such as a rapid aMMP-8 PoC immunotest, could be used as an adjunct to an interview/questionnaire to improve the precision of timely identification of asymptomatic, undiagnosed periodontitis patients by medical professionals. This strategy appears to be viable for referring patients to a dentist for diagnosis and treatment need assessment.

Highlights

The link between periodontitis and several systemic diseases (cancers, diabetes, cardiovascular diseases (CVDs), Alzheimer’s disease, etc.) and induced low-burden systemic inflammation makes periodontitis an important disease for dentists and for medical professionals [1,2,3,4,5,6,7]
Receiver operating curve (ROC) analysis of logistic regression models (Figure 1 and Table 1) indicated that biomarkers have good potential to increase the accuracy that a plain questionnaire offers for identification of undiagnosed periodontitis patients: Active matrix metalloproteinase (aMMP)-8 AUC = 0.834 (0.761–0.906), total MMP-8 = 0.800 (0.722–0.878), active MMP-9 = 0.787 (0.704–0.870), total MMP-9 = 0.767 (0.680–0.855) and calprotectin = 0.773 (0.687–0.858) adjunct with the questionnaire vs. plain questionnaire = 0.764 (0.676–0.851). active form of MMP-8 (aMMP-8) levels indicating active collagenolysis and periodontal degeneration had the best precision when adjunct with the questionnaire compared with total MMP-8, active MMP-9, total MMP-9 and calprotectin and the plain questionnaire to improve the identification of the undiagnosed periodontitis cases that need to be referred to a dentist (Figure 1 and Table 1)
Our results show that oral fluid biomarker analysis in adjunct with an interview/questionnaire, covering risk factors for periodontitis, could be a feasible tool for the timely identification of asymptomatic, undiagnosed periodontitis patients by medical professionals

Summary

Introduction

The link between periodontitis and several systemic diseases (cancers, diabetes, cardiovascular diseases (CVDs), Alzheimer’s disease, etc.) and induced low-burden systemic inflammation makes periodontitis an important disease for dentists and for medical professionals [1,2,3,4,5,6,7]. It is unfeasible for a medical professional to detect periodontitis due to a lack of both the equipment required for intraoral examination, as well as professional knowledge regarding oral diseases and their diagnosis [8,9]. As these symptoms are typically associated with more severe stages of periodontitis, those who are asymptomatic will generally go undiagnosed

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