Seeing the forest for the trees

When we are so focused on the details rather than the big picture, we are not seeing the forest; we are only looking at individual trees. The dental profession is changing fundamentally, and this is an important time to step back and see the whole profession. The dental profession we currently practice in is getting close to what would have been considered science fiction just a short time ago. New diagnostic and treatment modalities are coming over the horizon in a nearly continuous stream. One of the trends involves the detection of many biomarkers in saliva.

The reason this is only now emerging is the ability to detect the very small concentrations of biomarkers in saliva compared to the blood. Biomarkers in saliva are commonly found in nanogram concentrations (one billionth of a gram) or picograms (one trillionth of a gram). The ability to detect these minute quantities is a recent phenomenon, hence the plethora of research using saliva as the testing medium rather than serum. Expectorating saliva is a lot easier and more tolerable compared to a blood draw to obtain a sample.

Another research advance that will modify the manner in which we care for our patients is the detection of bacterial RNA activity, specifically messenger RNA (mRNA). Whereas DNA bacterial analysis can detect the specific microbes that cause an individual patient’s periodontitis, RNA analysis provides information on the cellular events occurring in a patient with periodontitis, and which bacteria are transcribing genes for virulence factors, ultimately causing the clinical manifestations of disease that we see on a daily basis.

Another trend will be more and more chairside salivary detection of bacteria, disease activity, and biomarkers for a variety of diseases and conditions, not limited to the oral cavity. Sooner, rather than later, salivary samples will be obtained to detect biomarkers for head and neck cancer, sleep apnea, dental caries, periodontal disease, and Alzheimer’s disease, among many others. Seems like science fiction, but so did digital x-rays before they were available.