The Utility of Salivary Heme to Stratify Healthy Volunteers from Individuals with Gingivitis and Periodontitis: a Pilot Study

Abstract

Gingival bleeding due to poor oral hygiene is reported globally. Assessment of blood in saliva may improve diagnostics, serve as an outcome measure in clinical trials and support patient education through point-of-care tests. This work analyzed salivary heme using a rapid test format and separately using a lateral flow immunoassay assay [LF] for chair-side implementation. Clinical examinations stratified adult subjects into healthy, gingivitis or periodontitis groups at baseline. Healthy subjects presented no periodontal pockets and whole mouth gingivitis scores of less than 1.0.  Gingivitis subjects registered gingival index scores greater than 1.0.  Included in the periodontal disease group were subjects with periodontal pockets greater than 4 mm.  The rapid test is based on the peroxidase activity salivary heme converting a colourless probe to a coloured compound for spectrophotometric analysis.  For the LF assay, saliva was placed in the test window of the device with reactions scored after room temperature incubation.  Average salivary heme concentrations in the healthy, gingivitis and periodontal disease groups were 27, 201 and 326 nM respectively, by the rapid test, representing significant differences by analysis of variance and Tukey’s-multiple comparison tests (p<0.05).  Similarly, results in the LF assay demonstrated increasing band intensity from the healthy to the periodontal disease groups and was quantifiable by image analysis.   This pilot study emphasizes the potential efficacy of rapid heme measurement in investigations of oral health.