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Are our current tools enough to detect and monitor periodontal disease effectively?

Despite decades of research into the causes of periodontal disease, diagnosis still relies on traditional clinical parameters: probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and radiographic evidence of bone loss. These remain the gold standard.

But are they sufficient in capturing the full picture of the disease?

These methods tell us about the current status of the periodontium, but they fall short when it comes to identifying disease activity early or predicting its future progression—especially in patients who show sudden periodontal destruction without typical risk factors or systemic conditions.

Can we detect periodontal disease before clinical signs even appear?

Emerging evidence suggests that disease may begin at the microbial level, before the onset of inflammation or bone loss. This concept of a “dysbiotic onset” refers to early shifts in the oral microbiome—where certain bacteria, known as pathobionts, synergize within polymicrobial communities to tip the balance toward disease.

So, what if we could use microbial shifts as early warning signs?

Microbiological biomarkers are now being studied as potential diagnostic tools. These biomarkers—detectable in saliva, dental biofilm, or gingival crevicular fluid (GCF)—could allow clinicians to identify early dysbiosis, long before irreversible damage sets in. Studies suggest that they may also help track disease stability and progression over time.

Which microorganisms are under the spotlight?

Commonly investigated species include Aggregatibacter actinomycetemcomitans (especially the JP2 genotype), Porphyromonas
gingivalis, Tannerella forsythia, and Treponema denticola. Some studies have developed composite indices—like the subgingival microbial dysbiosis index —that integrate microbiome data and have shown high diagnostic accuracy (AUC > 0.95).

Why arenʼt we using these tests in clinical practice yet?

While the results are promising, most studies are small-scale, cross-sectional, or case–control in design. There’s considerable variation in sampling methods, microbial analysis techniques, and even definitions of periodontal disease, making it difficult to draw standardised conclusions.

What needs to happen next?

For microbial biomarkers to become part of routine periodontal diagnostics, we need:

Standardised sampling protocols and diagnostic criteria
Longitudinal, well-controlled studies with diverse populations
Clinically validated, easy-to-use chairside diagnostic tools

Where does this leave us today?

Traditional markers like the red complex and A. actinomycetemcomitans (JP2) have historically provided useful diagnostic clues, but our understanding of periodontal pathogenesis has evolved. The future lies in combining multiple microbial signals to better predict disease risk and activity—potentially transforming how we diagnose and manage periodontal disease.

Are we ready for the shift toward precision periodontology?

The path forward will depend on collaborative research, robust validation, and the development of tools that are both scientifically sound and clinically practical.

Reference:

Bostanci N, Manoil D, Van Holm W, Belibasakis GN, Teughels W. Microbial Markers for Diagnosis and Risk Assessment for Periodontal Diseases: A Systematic Literature Search and Narrative Synthesis. J Clin Periodontol. 2025 May 25. doi: 10.1111/jcpe.14183. Epub ahead of print. PMID: 40414257.

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