Chairside tests that examine the properties of human saliva can now help assess systemic health threats, including human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS) and human papillomavirus (HPV). As the use of these technologies becomes more commonplace, dental hygienists may soon be among the first clinicians to recognize signs of these and other diseases—and facilitate referral for treatment. This Sunstar E-Brief provides an overview of salivary diagnostics and offers insight about these tests’ accuracy, effectiveness and most valuable attributes.
Collecting biological information from patients can be challenging. This is underscored by the difficulty in extracting blood from infants, children and older adults, who may object—sometimes physically—to traditional needle-stick testing. Diagnostic methods that rely on a simple saliva swab offer an attractive alternative.
The modern form of salivary diagnostics emerged in the early 1900s when Joseph P. Michaels, DDS, and E.C. Kirk, DDS, began microscopic and chemical examinations of saliva. Their methods tested for acidity, alkalinity, ammonium salts, sulphocyanates and chlorides.1,2 Today’s salivary diagnostics are capable of detecting the presence of HPV—which has been linked to oral cancer—and periodontal pathogens. Likewise, oral fluid tests have been developed that can detect HIV and signs of substance abuse.
The diagnostic information contained within saliva compares closely with that found in blood, which includes data carried by agents such as messenger RNA,3 hormones, proteins, DNA, metabolites and immune effectors.4 The value of this health data positions salivary diagnostics as a convenient, noninvasive tool that allows clinicians to provide personalized care.
WHAT SALIVA TESTING REVEALS
Salivary diagnostics can improve the patient experience at the dental office in several ways. The ease of collection, for example, can benefit patients as well as practitioners.4 Furthermore, saliva-based tests can circumvent the fear of needlestick that is experienced by some patients.4 By eliminating the need for a phlebotomist, these tests also typically reduce the cost of sample collection and pose a lower risk of percutaneous injury.4
Daniel Malamud, PhD, a professor at New York University College of Dentistry and NYU School of Medicine, says the benefits include a high level of sensitivity and specificity. Malamud, who specializes in infectious diseases and directs a university-based HIV/AIDS research program, gives salivary diagnostics satisfactory marks for accuracy. Compared to blood testing,” he says, “the results for most of the tests are equivalent—though saliva tests may not perform as well as blood tests in generating quantitative data.” This is because salivary tests typically provide a yes/no answer that, while expedient, may not offer the most complete picture of a patient’s health status.
But despite providing point-of-care diagnostics, this modality’s speedy turnaround may not be its most important characteristic. According to Malamud, “The greatest attribute of salivary diagnostics is that it allows a patient to be tested via an oral swab instead of a blood draw or finger stick.”
Many people are adversely affected by blood injury injection phobia, also referred to as BII.5 One trigger of BII is observing the flow of blood into a syringe.5 Patients who see their blood may experience a vasovagal response, which is a common physiological reaction associated with blood-phobic individuals. This is characterized by an increase—and then drop—in heart rate and blood pressure, potentially leading to dizziness, sweating, tunnel vision, nausea or fainting.5
The ability to immediately treat or refer a patient is a definite advantage. “If blood draw is used for testing, there will be a considerable delay in getting results. And when those results arrive, they may be provided by someone who does not refer the subject to the appropriate health professional,” Malamud explains. “For salivary diagnostics to have the greatest impact, their findings must be used to make a referral when necessary and help move the patient along the continuum of care.”
ORAL HEALTH, SYSTEMIC HEALTH
As the use of salivary diagnostics grows, preventive medicine will increasingly be carried out in the dental office.6 Under this scenario, the role of dental hygienists as watchdogs of oral-systemic health may enable considerable professional growth. Malamud suggests there will be more oral tests in the future, and—if carried out in a dentist’s office—these will most likely be administered by a dental hygienist or dental assistant.
The major roadblock at this time is reimbursement for testing, Malamud notes. Payers, patients and clinicians likely will carry on the debate, with progress toward greater acceptance and reimbursement occurring gradually. Meanwhile, research into this technology is moving forward at facilities such as the Forsyth Center for Salivary Diagnostics inCambridge, Massachusetts, where teams are striving to replace blood tests with saliva-based testing.4 The institute is involved in work that analyzes salivary biomarkers for pre-diabetes/metabolic syndrome in children, and tests for active tuberculosis and progressive periodontitis. Researchers are also identifying biomarkers that point to heightened risk of stroke, Alzheimer’s disease, type 2 diabetes and heart disease.4
In addition, manufacturers are working to miniaturize saliva-based testing, with the goal of transforming this technology into what is colloquially referred to as a “lab on a stick.” The idea is to offer a device roughly the size of a computer chip that can evaluate the presence of several key biomarkers in a saliva sample.7
As technology boosts the sophistication of diagnostic tools, dental hygienists may soon find themselves on the frontlines of their patients’ overall health care. Dental hygienists should consider how to best prepare for this new dimension in professional services. Toward this end, savvy clinicians will seek to strengthen their understanding of the oral-systemic link and refine their ability to communicate with medical personnel in interprofessional collaboration.
- Michael JP. Saliva as an aid in the detection of diathetic diseases. Dent Diag. 1901;7:105–110.
- Kirc EC. Saliva as an index of faulty metabolism. Dent Diag. 1903;9:1126–1138.
- Henson B, Zentz R, Wong DT. American Dental Association. A Primer on Salivary Diagnostics. Available HERE. Accessed February 24, 2015.
- Forsyth Center for Salivary Diagnostics. Salivary Diagnostic. Available HERE. Accessed February 24, 2015.
- Sanford J. Blood, Sweat and Fears. Available HERE. Accessed February 24, 2015.
- American Dental Association. Salivary Diagnostics. Available HERE. Accessed February 24, 2015.
- Sandia National Laboratories. Sandia handheld instrument assesses dental disease in minutes. Available HERE. Accessed February 24, 2015.
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