Salivary Markers in Periodontal Disorders

October 14, 2025 updated by: Midwestern University

Use of Salivary Markers to Heralding the Onset of Periodontal Disorders

The swelling of the gum, or periodontitis, is the leading cause for tooth loss, and currently affects up to 65 million adults only in the United States. One of the reasons for the widespread of periodontitis is because currently there are no definitive methods to detect the onset of gum disease. This lack of foresight impedes medical professionals to enact any preventive measures before the disease already manifests itself.

We wish to expand our understanding towards the development of periodontitis by studying the expression and activity of salivary markers that have been associated with advanced stages of the disease, wherein the supporting tissues of tooth (periodontium) are already irreversibly destroyed. We hypothesize that a progressive shift in the expression of such salivary markers can indicate a change or evolution of periodontitis staging.

In specific, we seek to establish a quantifiable relationship among levels of salivary proteases called MMPs, level of metal ions in different stages varying from health to periodontitis. The overall goal of this proposal is to enhance the predictability of periodontitis, as we are currently unable to diagnose the disease until the manifestation of its clinical signs and symptoms.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

There is an urgent need for an efficient system to diagnose periodontal disease in its early stages. A recent investigation on the prevalence of periodontitis in adults living in the USA revealed that almost 50% of the assayed individuals had periodontal disease. Research on the economic burden of oral diseases estimated that productivity losses due to severe periodontitis and, consequently, due to tooth loss in North America (US and Canada) amounted US$ 116 billion yearly. This pervasiveness of periodontitis can be attributed to the conventional method of diagnosis, which is entirely based upon recognizing observable signs - an assessment of the disease's history.

A crucial restraint of these observable parameters is that they do not detect present disease activity and, therefore, cannot provide a real-time evaluation of the disease status. The lack of evidence-based knowledge regarding periodontal diseases activity and level of progression may ultimately lead to unintentional clinical mismanagement [6]. Accordingly, there is an unmet requisite for easy and readily available methods to herald the periodontium health condition prior to the manifestation of disease clinical signs [7].

Periodontal diseases are identified as being resultant from an inflammatory, host-mediated response, associated with dysbiotic plaque biofilms. Within the inflammatory host response of periodontal diseases there is a group of enzymes that are key, the matrix metalloproteinases (MMP). The abundance of MMPs, more specifically MMP-8, in saliva of individuals with severe periodontitis has shown to be high. In physiological conditions, the activity of MMPs is tightly controlled by changes in the balance between their expression and the expression of their major tissue endogenous inhibitors, called TIMPs. In addition, the catalytic competence of MMPs is highly dependent on the concentration of specific metal ions, zinc and calcium, which justifies the use of the prefix "metal" to classify and group this proteinase superfamily. As MMP-inhibitory medication has been shown to reduce the levels of MMPs in oral fluids, we hypothesize that collection of oral fluid samples (i.e., saliva and/or gingival crevicular fluid) from individuals appertaining to different stages of periodontal diseases can identify a shift in the balance between MMPs and their tissue-regulatory factors.

The overall objective of this proposal is to contribute to enhance the predictability of periodontitis and identify a method to heralding its onset. We hypothesize that the levels of salivary MMPs and other factors modulating these enzymes activity relate with different clinical stages of periodontal disease. The questions this research will address are: Do the level of MMPs vary as a function of periodontium health state? Is there a quantifiable relationship between salivary MMPs and other markers, such as MMP-Tissue Inhibitors (TIMPs) and metal ions, in the context of periodontitis?

Thus, the specific aims of this purposed study are:

  • To measure the levels of MMPs and MMPs' tissue-regulatory factors (TIMPs and metal ions) in oral fluids of adults displaying different clinical status of periodontium integrity, from health (stage 0) to severe periodontitis (stage IV).
  • To determine the relationship of periodontitis clinical staging and levels of salivary MMPs and MMPs regulatory factors.

Study Type

Observational

Enrollment (Actual)

106

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Illinois
      • Downers Grove, Illinois, United States, 60515
        • Midwestern Univerity

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

N/A

Sampling Method

Probability Sample

Study Population

The literature does not display a consistent number of estimate participants for reliable assessment of salivary markers; with correlate studies reporting to have included from 100 to 1000 participants. We aim to invite up to 200 subjects to participate in this research. Subjects will be allocated into four categories following the four stages of periodontitis from AAP classification, plus a fifth category as periodontal health individuals for control group. The results of this cohort will be analyzed to detect an effect size of 0.5 at the 0.05 significance level.

Description

Inclusion Criteria:

  • (1) 40 years of age or older with a healthy medical history and not meeting any of the exclusion criteria;
  • (2) requiring definitive periodontal treatment/routine care; and
  • (3) retaining a minimum of 20 teeth and without active carious lesions

Exclusion Criteria:

  • 1) with systemic illness affecting their immune system (i.e. diabetes, rheumatoid arthritis, etc);
  • (2) currently on chronic anti-inflammatory medications (i.e. steroids, TNFα-inhibitors, etc); and
  • (3) previously underwent active periodontal therapy within the past 2 years;
  • (4) who cannot read or speak English.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Perio-Healthy
Individuals included in this cohort, other than meet the eligibility criteria, should present no clinical sign of periodontal disease. We anticipate to find from a very small number to none participants at this cohort. No intervention are anticipated.
Other: This is an observational study, no intervention is anticipated.
There is no intervention. This is an observational study.
Periodontitis Stage I
Individuals included in this cohort, other than meet the eligibility criteria, should present clinical sign of periodontal defined as Stage I according to the American Academy of Periodontology. We anticipate low to moderate number of participants in this cohort. No interventions are anticipated.
Other: This is an observational study, no intervention is anticipated.
There is no intervention. This is an observational study.
Periodontitis Stage II
Individuals included in this cohort, other than meet the eligibility criteria, should present clinical sign of periodontal defined as Stage II according to the American Academy of Periodontology. We anticipate a moderate number of participants in this cohort. No interventions are anticipated.
Other: This is an observational study, no intervention is anticipated.
There is no intervention. This is an observational study.
Periodontitis Stage III
Individuals included in this cohort, other than meet the eligibility criteria, should present clinical sign of periodontal defined as Stage III according to the American Academy of Periodontology. We anticipate moderate to high number of participants in this cohort. No interventions are anticipated.
Other: This is an observational study, no intervention is anticipated.
There is no intervention. This is an observational study.
Periodontitis Stage IV
Individuals included in this cohort, other than meet the eligibility criteria, should present clinical sign of periodontal defined as Stage IV according to the American Academy of Periodontology. We anticipate low to moderate number of participants in this cohort. No interventions are anticipated.
Other: This is an observational study, no intervention is anticipated.
There is no intervention. This is an observational study.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Matrix Metalloproteases (MMPs) Salivary Levels
Time Frame: October 2024
Levels of MMPs assessed by different immuno-assays.
October 2024
Levels of Metal Ions
Time Frame: October 2024
Levels of metal ions assessed by Inductively Coupled Plasma Dynamic Reaction Cell Mass Spectrometer
October 2024

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Potential Correlation of MMPs, Metal Ions and Peridontitis Staging
Time Frame: October 2024
The relationship between salivary MMPs and identified metal ions for all cohorts (periodontally healthy and periodontitis-affected individuals) will be determined by multiple regression analyses.
October 2024

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Midwestern University

Investigators

  • Principal Investigator: Marcela Rocha de Oliveira Carrilho, DDS, PhD, Midwestern University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

November 6, 2021

Primary Completion (Actual)

October 10, 2023

Study Completion (Actual)

October 10, 2024

Study Registration Dates

First Submitted

August 27, 2024

First Submitted That Met QC Criteria

August 27, 2024

First Posted (Actual)

August 29, 2024

Study Record Updates

Last Update Posted (Estimated)

October 16, 2025

Last Update Submitted That Met QC Criteria

October 14, 2025

Last Verified

October 1, 2025

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 20082 (Other Identifier: Fred Hutch/University of Washington Cancer Consortium)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Individual participant data (IPD) will not make available to other researchers.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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