Point-of-Care Periodontitis Testing: Biomarkers, Current Technologies, and Perspectives

Periodontitis has wide prevalence and distribution, and is associated with the progression of several systemic diseases (e.g., diabetes, atherosclerosis, cancers, and Alzheimer's disease). Preventing and treating periodontitis is beneficial to oral and general health, and diagnosis and surveillance of periodontitis are especially important. Existing clinical diagnostic methods for periodontitis can reflect its severity and previous periodontal destruction, but they fail to reflect its present state or allow monitoring and predict its progress. By contrast, periodontitis-related biomarkers can indicate current disease conditions and evaluate treatment effects and future risk. POCT can detect periodontitis biomarkers onsite within 20 minutes. Its low cost, ease of use, and speed can help people to pay closer attention to their oral health and decrease the need for dental procedures. Periodontitis has become one of the most universal chronic inflammatory diseases worldwide. Subclinical symptom progression, ultimately leading to permanent damage, calls for early diagnosis and long-term monitoring. However, traditional clinical diagnostic methods are complex and expensive, and cannot meet these requirements. Recently, with more biomarkers and the development of new technologies, various point-of-care testing (POCT) platforms have been developed for periodontitis diagnosis and monitoring. These are easy to perform, rapid, low-cost, and are perfectly suited for high-frequency diagnosis of periodontitis at the point-of-care (POC). We summarize existing biomarkers of different periodontitis stages and recent developed POCT platforms (including lab-on-a-chip, paper-based platforms, and chairside tests), discuss their existing challenges and future potential, and provide some inspiration and guidelines for future POC periodontitis testing. Periodontitis has become one of the most universal chronic inflammatory diseases worldwide. Subclinical symptom progression, ultimately leading to permanent damage, calls for early diagnosis and long-term monitoring. However, traditional clinical diagnostic methods are complex and expensive, and cannot meet these requirements. Recently, with more biomarkers and the development of new technologies, various point-of-care testing (POCT) platforms have been developed for periodontitis diagnosis and monitoring. These are easy to perform, rapid, low-cost, and are perfectly suited for high-frequency diagnosis of periodontitis at the point-of-care (POC). We summarize existing biomarkers of different periodontitis stages and recent developed POCT platforms (including lab-on-a-chip, paper-based platforms, and chairside tests), discuss their existing challenges and future potential, and provide some inspiration and guidelines for future POC periodontitis testing. a Gram-negative coccobacillus that can contribute to bacterial adhesion and produce many virulence factors (e.g., leukotoxin, bacteriocin, and chemotaxis inhibiting factor) to modulate the host response and contribute to tissue destruction. an enzyme that catalyzes the transfer of an amino group from glutamic acid to oxaloacetic acid. AST is found in abundance in fibroblasts, epithelial cells, and polymorphonuclear cells. It generally intracellular, but is released into the extracellular environment upon cell death, thereby indicating tissue destruction. the process of examining large datasets (i.e., big data) to uncover hidden factors, unknown correlations, potential risks, customer preferences, and other useful information. in dentistry, a type of bacterial plaque that cannot be washed away. It is a soft and non-mineralized bacterial colony that adheres to the surfaces of teeth and prostheses. The formation of biofilm is the basis of survival, metabolism, and pathopoiesis of bacteria. a serine endopeptidase stored in the azurophilic granule in granulocytes which can react with a wide range of protein substrates (e.g., fibrinogen, proteoglycans, elastin, and collagen) and participate in tissue breakdown and combating infection. the fluid in the gingival sulcus – a narrow crevice between the free gingiva and tooth surface. GCF is mainly composed of factors (including cells, proteins, electrolytes, enzymes, etc.) derived from the gingival sulcular epithelium. a proinflammatory cytokine that can recruit immune cells towards sites of infection and promote bone resorption by stimulating the release of PGE2 and metalloproteinases from fibroblasts and monocytes. IL-1β is the predominant form of IL-1 in periodontal tissues, and higher levels of IL-1β are usually found in active periodontitis sites than in inactive periodontitis sites. a field of computer science that uses statistical techniques to give computer systems the ability to ‘learn’ (e.g., progressively improve performance on a specific task) from data without being explicitly programmed. MMPs are the most prominent and extensively studied proteinase family associated with periodontitis, and can synergistically degrade almost all basement membrane components and the extracellular matrix. MMP-8 is a member of the collagenolytic MMP family and is produced and activated by host inflammatory mediators such as IL-1β and TNF-α. Levels of MMP-8 are significantly higher in the GCF of periodontitis patients than that of healthy people and gingivitis patients, and it is more abundant in the active stage than in the resting stage. Its levels decrease after periodontal treatment. can prevent RANKL protein from contacting the RANK receptor, thereby reducing osteoclastogenesis. this Gram-negative bacterium contains many virulence factors (e.g., lipopolysaccharides, proteases, and fimbriae), can degrade collagen and connective tissue proteins, and can coaggregate other bacteria to induce more damage to the host tissue and cells. a Gram-negative bacillus and one of the periodontal pathogens classified as the ‘orange complex’. derived from arachidonic acid metabolism, PGE2 is associated with changes in fibroblast metabolism, soft tissue destruction, and bone resorption. this protein binds to RANK receptors on the surface of osteoclasts, and binding activates osteoclastogenesis and induces bone resorption. a Gram-negative bacterium that contains multiple assumed virulence factors such as hemagglutinin, a trypsin-like protease, and cell surface-associated and secreted protein (BspA), and is crucial for alveolar bone absorption. a small spirochete that is generally found together with Pg in progressing periodontitis and has a symbiotic nutrient-utilization relationship with Pg. produced by activated macrophages, TNF-α has a strong potential to increase bone resorption and degrade connective tissue by stimulating collagenase and PGE2.