Some developments from salivary analytes obtained from these biomark-ers have indicated inflammation, osteo-clastic and osteoblastic formation. 9,11 This information can be potentially useful in dentistry, especially orthodon-tics and periodontics. Research has shown a response that arises from the start of tooth movement is initially inflammation. 11 If a dentist can deter-mine when inflammatory mediators are present by immediately collecting a saliva sample at the start of a patient appointment, and then retrieving the results in real time, a more individual-ized treatment plan can be prepared for the patients. Application of salivary analytics can assist dental providers in determining if they should proceed with appliance application and tooth movement, temporarily wait or inter-vene with host modulation. The outcome provides the practitioner with confidence in their recommended treat-ment protocol. Additionally, there are numerous other limitations to the periodontal probe. 9 For instance, how many clini-cians have the same sense of weight and pressure with their hands? How many clinicians determine the exact millimeter as the next from eyesight alone? There have been attempts to rule out this lack of precision with tools such as the Florida Probe, yet chal-lenges may still occur if calculus is present and /or maneuvering around orthodontic appliances. In orthodontics there are very precise measurements and assessments to initially diagnose and identify an individualized treatment plan. This type of precision and accuracy in detection and management of oral diseases is what the utilization of sali-vary diagnostics has been shown in research to provide. 12 settings, the two LDT tests by OralDNA Labs can serve as starting points for implementation in daily practices. The current methods of disease detection in dentistry fall short in comparison to laboratory analytics. DENTAL CARIES Dental Caries is more simple to diagnose clinically under optimal conditions. G.V. Black's classification of I, V and VI most times are identi-fied through clinical assessment alone. The other classifications, along with the presence of dental materials, are visually and radiographically more challenging in diagnosing decay. An example may be dental crowding and irregular tooth posi-tioning. The use of carious lesion detection devices such as quantita-tive light fluorescence, laser caries illumination and detection devices, and photo-thermal radiometry, has been beneficial, but there are still limitations along with the lack of cost reduction. Some adjunctive devices require a "virgin" tooth and when sealants or restorations are present the accuracy of these tools can be inhibited. The traditional dental explorer or shepard's hook has been a controversial tool in minimally invasive dentistry due to the potential of disturbing the remineralization process and further enhancing demineralization. WHY IS SALIVARY DIAGNOSTICS IMPORTANT FOR DENTISTRY? There are three major stomatog-nathic diseases dentistry deals with on a daily basis. They include periodontal disease, dental caries, and oral cancer; oral squamous cell carcinoma (OSCC) and head and neck squamous cell carci-noma (HNSCC). Each disease has presented dental providers with a chal-lenge in risk assessment and prognos-tics, which directly affects early diagno-sis, individual treatment and monitor-ing. In all disciplines of dentistry, these oral diseases are problematic and often-times compromise patient care and can lead to a lack of trust and loyalty from patients to other providers. WHAT SALIVARY TESTS ARE AVAILABLE FOR IMPLEMENTING PERIODONTAL DISEASE DETECTION IN DAILY PRACTICE? There are salivary tests for peri-odontal disease analysis that are lab-developed tests (LDT). They are avail-able through the Clinical Laboratory Amendments Act (CLIA) approved facilities in the United States. One test detects the salivary biomarkers, which informs the provider and patient of their genetic susceptibility to inflammation and risk of peri-odontal disease (MyPerioID®, OralDNA Labs, Eden Prairie, MN). The other test is a bacterial test and provides information on the type and amount of pathogens within a patient's saliva (MyPerioPath®, OralDNA Labs, Eden Prairie, MN). These two salivary tests have been around for a while and are not new to dentistry, yet still remain under-utilized within the 50 states. Neither of these LDT's provides dentistry with convenience, nor enables a significant cost reduction due to shipping fees, the total cost of supplies, and waiting on labora-tory reports. 12 A point-of-care (POC) salivary test would be ideal. This test would sample and analyze oral biological fluids in real time. 10,12 However, until these POC tests are made available in clinical WHAT SALIVARY TESTS ARE AVAILABLE FOR IMPLEMENTING DENTAL CARIES DETECTION IN DAILY PRACTICE? There are a few salivary tests on the market for dental caries that are also not new to the dental profes-sion; most have a 48-hour wait/incu-bation period. Currently, there is a POC test called Saliva-check SM by GC America Inc. (Chicago, IL), which determines an amount of cariogenic bacteria present; specifically the streptococcus mutans. As mentioned earlier, POC testing remains the most cost-effective, conve-nient and timely test available now and is one goal for future salivary bio-molecular assays that will be used outside of research. 9, 10 PERIODONTAL DISEASE Diagnosis of periodontal disease relies primarily on clinical and radio-graphic findings. The clinical reliability is largely based on a periodontal probe with the presence of bleeding. 9 Bleeding is not foolproof, as we all know many smok-ers do not exhibit the signs of inflam-mation and bleeding is often absent even in the presence of disease. Clini-cian technique and medications also contribute to bleeding. www.orthodontics.com Summer 2016 33
Journal of the American Orthodontic Society Summer 2016 / Buyer's Guide: Page 33
