Resumen de Pilot Study on Oral Health Status as Assessed by an Active Matrix Metalloproteinase-8 Chairside Mouthrinse Test in Adolescents
Anna Maria Heikkinen, Solomon O. Nwhator, Nilminie Rathnayake, Päivi Mäntylä, Päivi Vatanen, Timo Sorsa
Background: Matrix metalloproteinase (MMP)-8 is a major destructive collagenase involved in periodontitis and can be regarded as a periodontitis biomarker. A neutrophil collagenase 2 (active MMP-8 [aMMP-8]) oral fluid immunoassay has recently been demonstrated to be a periodontitis risk indicator among adults. The aim of this study is to investigate whether a point-of-care mouthrinse test based on an aMMP-8 immunoassay could identify patients with oral inflammatory burden (periodontitis and caries) among adolescents with early pathologic findings.
Methods: This cross-sectional study was carried out at the Kotka Health Center, Finland. First, the aMMP-8 chairside mouthrinse test was performed on enrolled individuals (adolescents aged 15 to 17 years, n = 47), and the results were read based on a color change within 5 minutes. Then, full-mouth clinical parameters of oral health were assessed, including periodontal, oral mucosal, and caries status.
Results: The sensitivity and specificity of the test for bleeding on probing were 71.8% and 77.5%, respectively (P = 0.05); for ≥1 site with probing depth (PD) ≥4 mm, 48.3% and 100% (P <0.001); for ≥2 sites with PD ≥4 mm, 63.6% and 100% (P <0.001); and for >2 sites with PD ≥4 mm, 76.5% and 96.7% (P <0.01). Regarding periodontitis (≥1 site with PD ≥4 mm), hardly any false-positive results were identified. The sensitivity of the immunoassay for ≥1 caries lesions was 76.5%, and the specificity was 96.7% (P <0.01).
Conclusions: In 5 minutes, the aMMP-8 chairside test showed promising results, recognizing oral inflammatory burden in adolescents with early initial signs of periodontitis. Caries lesions could also be detected, but less efficiently.
Recent studies reveal that oral fluid biomarkers can be used for detection of both oral and systemic diseases, including periodontal disease.1-7 Mouthrinse could offer an inexpensive and easy means of collecting oral fluid, in particular for an adjunctive point-of-care (POC) periodontitis diagnostic.8 The authors have recently published a study based on salivary matrix metalloproteinase (MMP)-8 and -9 in relation to coronary heart disease and periodontal disease, wherein salivary levels of MMP-8 and -9 were associated with periodontal status.4 MMP-8 is a major destructive collagenase in periodontitis,7 and MMP-8 in oral fluids could have a predictive value.7,9-11 Indeed, the progression of periodontitis has been repeatedly associated with pathologically excessive elevation of MMP-8 in oral fluids.6,7,12,13 Immunoassays for MMP-8 detection, which target polymorphonuclear leukocyte (PMN)–type and fibroblast-type MMP-8 isoenzyme species in oral fluids, have been found to be beneficial to differentiate sites with periodontitis and gingivitis from healthy sites.6,12 In addition, Hedenbjörk-Lager et al.14 reported that elevated salivary MMP-8 levels seemed to be associated with caries lesions.
A number of studies have measured MMP-8 in gingival crevicular fluid and saliva,1-4,7,13,15 but there is a gap in knowledge based on the utility of a POC oral fluid MMP-8 test for chairside diagnostics of periodontal disease.7 According to studies by Heikkinen and colleagues,16,17 10% to 15% of 15- to 16-year-olds were observed to suffer from initial chronic periodontitis (CP). In this context, a chairside mouthrinse test based on an active MMP-8 (aMMP-8) immunoassay for measuring oral inflammatory burden among adolescents is of high interest. The aim of this study is to assess the sensitivity and specificity of a POC collagenase 2 (aMMP-8)–based immunoassay‖ in detecting oral inflammatory burden, periodontitis, and caries among Finnish adolescents.
