The Future of Personalized Dentistry by Dr. Katie To

Why saliva is becoming the gateway to personalized dental care, why microbial and host-response periodontal testing is at its most actionable application today, and why licensed dentists should be the ones ordering it

by Dr. Katie To

When a physician wants to understand what is happening inside a patient, they draw blood: a lipid panel, an A1c, a C-reactive protein level. The fluid turns the invisible into something measurable, and the measurement drives the plan. Dentists have an equivalent fluid, and it sits in every operatory at every appointment, no needle required: saliva.

Personalized medicine has spent the last decade moving from idea to standard of care, built on a simple premise: We treat people more effectively when we measure what is actually happening in their bodies rather than averaging across a population. Dentistry is now on the same path, and saliva is its most practical entry point. Salivary biomarkers have been described in the literature as a gateway to personalized dental diagnostics.¹ The tools to read them exist, several are validated for specific applications, and they are increasingly available direct to consumers whether dentists participate or not.

That last point deserves attention. Patients are already ordering saliva tests online, and a growing number of physicians focused on the oral-systemic connection are beginning to ask their patients to work with a dentist who tests. The question is no longer whether saliva testing has a place in dentistry. It is whether dentists will interpret the results, or whether we will hand that role to a mail-order kit and a referring physician’s best guess.


Why saliva, and why now
Saliva is not a perfect mirror of the bloodstream, and an honest discussion has to start there. Its composition shifts with age, diet, medication, and time of day, and the field still lacks fully standardized protocols for collection and analysis.^2,3 Those limitations are real, and they are why saliva has not replaced blood for most systemic markers.

For a defined set of analytes, though, the correlation is strong and the noninvasive advantage is decisive. Salivary glucose tracks reasonably with blood glucose, salivary C-reactive protein has been linked to cardiovascular risk, and saliva has been studied as a medium for detecting conditions from diabetes to certain cancers.^4,5 Collection is painless, repeatable, and safe to handle, which makes longitudinal monitoring practical in a way a blood draw never will be in a dental chair.

For dentistry, the most compelling case is not systemic screening. It is the disease we own outright: periodontitis. Periodontal disease is a polymicrobial biofilm infection that provokes a host inflammatory response, and saliva captures both signals. That is where salivary testing stops being interesting and becomes clinically actionable, and it is where this article spends most of its time.


The anchor: Reading periodontal disease in two dimensions
Periodontitis affects a large share of the adult population and is driven by specific bacterial species acting as a community, not in isolation. The limitation of the probe and the radiograph is timing. They confirm damage after it happens. Salivary testing changes the sequence by measuring two things conventional tools cannot: which pathogens are present and in what quantity, and whether host tissue is actively breaking down right now.

Who is there: Microbial testing
The microbial evidence is the strongest in the salivary diagnostics literature. In the Parogene study of 462 patients, salivary concentrations of Porphyromonas gingivalis, Tannerella forsythia, and Prevotella intermedia were significantly higher in patients with moderate to severe periodontitis than in those with none to mild disease, and the combined burden of multiple pathogens carried more diagnostic value than any single organism.⁶ The first two sit in the group Socransky’s classic work labeled the red complex, long associated with destructive disease. The clinical takeaway is direct: A test that quantifies a panel of pathogens outperforms one chasing a single organism.

This is the category OralDNA’s MyPerioPath helped establish, and it remains one of the longest-standing and most widely used clinician-ordered salivary platforms in dentistry. The method is quantitative real-time PCR, which amplifies and counts specific bacterial DNA sequences from a simple oral rinse.⁷ The output is not a yes or no. It is a quantified pathogen load you can act on and, just as important, remeasure.

Fig. 1: One patient’s salivary periodontal pathogen levels at baseline (Feb. 10, 2025) and at 11-month follow-up (Jan. 6, 2026), charted from the patient’s salivary pathogen test reports. After periodontal therapy, total pathogen burden fell 86 percent: All three high-risk species (Pg, Tf, Td) and three of the four moderate-risk species (En, Fn, Cr) dropped below the limit of quantification, while one moderate-risk species (Pi) and the low-risk species (Cs) persisted. Aa, Pm, and Ec were not detected at either timepoint.

Remeasurement is where microbial testing earns its place in a workflow. A 2025 longitudinal study using a salivary RT-PCR platform found that professional hygiene reduced periodontal pathogens by one to two logs, with the total pathogen burden score falling from a mean of 8.7 to 4.1, and that roughly 69% of untreated controls saw bacterial rebound within three months.⁸ Probing cannot show that. A pathogen count can. It tells the clinician whether therapy worked, whether a patient is trending back toward disease and when to intervene again, rather than waiting for the next round of attachment loss.

What they are doing: Host-response screening
Knowing which bacteria are present is only half the picture. It does not tell you whether the patient’s tissue is degrading at this moment, and two patients with similar bacterial profiles can have very different disease activity depending on their immune response. This is where host-response testing comes in. Dentists are increasingly fielding questions about the test for active matrix metalloproteinase-8, or aMMP-8.

aMMP-8 is a collagen-degrading enzyme released by neutrophils during active periodontal breakdown. Because the active form specifically, rather than total or latent enzyme, signals current tissue destruction, it functions as a real-time indicator of disease activity.⁹ It can be measured chairside from a mouth rinse with a lateral-flow test and a digital reader, with results in about five minutes, which makes it the most practical in-office screening option available.¹⁰ In a staging study, the chairside test showed sensitivity near 84% and specificity near 79%, and detected elevated inflammatory activity even at early stages.¹¹

The right way to frame aMMP-8 is exactly as a screening tool, not a diagnostic endpoint. A positive result flags active breakdown that warrants a full periodontal evaluation. It does not, on its own, stage disease or replace the clinical exam and the microbial picture. Used that way, it is a fast, low-friction way to catch active disease early and to monitor whether treatment is calming the inflammatory response. Paired with microbial testing, it answers the two questions that matter: Who is driving the disease, and is it actively progressing.


Beyond perio: The broader menu
Periodontal testing is the anchor, but saliva carries other signals worth knowing, even where they sit further down the evidence curve.

Oral HPV is the most clinically significant, given the rise in HPV-associated oropharyngeal cancer. Salivary detection of high-risk HPV shows good specificity, around 90%, but only moderate sensitivity, around 72%, which means a negative result does not rule disease out.^12,13 Just as important: There are currently no FDA-approved salivary HPV tests, and available assays are best understood as risk-awareness tools rather than screening or diagnostic confirmation.¹³ Framed that way, they have a place. Sold as a definitive screen, they overpromise.

Saliva is also used to gauge caries risk by quantifying acidogenic bacteria such as Streptococcus mutans, to detect Candida, and through some labs to measure hormones and cortisol.¹⁴ Host genetic susceptibility testing, which examines inflammatory markers such as interleukin-1 genotype, has been offered to flag patients predisposed to a stronger inflammatory response. These applications range from useful adjunct to investigational, and a dentist evaluating any of them should ask the same question of each: What is the method, and what has it been validated to tell me.

That question is the durable skill. So before comparing companies, it helps to understand the methods, because the method determines what a result can mean.

Fig. 2: A salivary collection kit in the author’s office. The patient swishes and gargles a saline rinse for at least 30 seconds, then spits into the funneled collection tube; the sealed, bagged specimen is mailed to the laboratory. Chairside collection takes only minutes.

The method determines the meaning
Three core technologies dominate salivary testing, and they are not interchangeable.

Quantitative real-time PCR (qPCR or RT-PCR) targets known sequences. You decide in advance which pathogens to look for, and the test reports whether they are present and in what quantity. It is precise, quantitative, reproducible, and well suited to tracking a defined panel of periodontal pathogens over time. Its limitation is its design: It finds only what it is built to look for. This is the engine behind the clinician perio tests.

Next-generation sequencing using shotgun metagenomics takes the opposite approach. Rather than targeting, it sequences the genetic material present and reconstructs the broader community, often hundreds of species of bacteria and fungi. Its strength is breadth. Its output is typically relative abundance, a percentage of the whole, rather than an absolute quantified load, which makes it excellent for describing an ecosystem and weaker for the precise, repeatable single-pathogen tracking perio monitoring needs. This is the technology behind several consumer microbiome tests.

Metatranscriptomics sequences RNA rather than DNA, capturing gene expression, what the microbes are actively doing rather than only who is present. It is the most information-rich and the least standardized for routine clinical use.

Host-response tests such as aMMP-8 sit in a different category altogether. They measure the patient rather than the microbes, which is why they complement the bacterial tests instead of duplicating them.

None of these is better in the abstract. They answer different questions. For quantifying and monitoring periodontal pathogens, targeted qPCR is the most fit for purpose. For exploring the wider oral ecosystem, sequencing has the edge. For a fast read on active disease, the chairside host-response test wins. A dentist who understands these distinctions can evaluate any test on the market and explain to a patient why a broad consumer microbiome report and a clinical perio panel are not measuring the same thing.


Clinician tests and the direct-to-consumer wave
That distinction becomes practical the moment a patient arrives with a direct-to-consumer report.

Consumer oral microbiome testing has grown quickly. The appeal is obvious: Order online, spit in a tube, receive a colorful report and a product recommendation. The caution is equally real. As a category, direct-to-consumer microbiome testing faces documented questions about analytical and clinical validity, because there are no regulatory-approved microbiome diagnostic tests and no settled definition of a healthy microbiome to measure against.^5,15 A report can be analytically interesting and still not support the clinical conclusions or supplement recommendations layered on top of it.

This is not an argument against the tests. It is an argument for the dentist as interpreter. When a patient brings in a consumer report, they need someone who can separate the validated signal from the wellness narrative, set it beside a clinical exam, and decide what, if anything, to do. That someone should be their dentist.

Certification is often misunderstood, and it matters here. Certification under the Clinical Laboratory Improvement Amendments (CLIA) means a laboratory meets quality standards for running tests. It does not mean a given test is FDA-approved or clinically validated for the claims attached to it. Both clinician and consumer tests can be CLIA-certified while differing enormously in what their results justify.


The next step belongs to dentists
Here is the practical case for acting, not just reading.

Dentists are the licensed practitioners closest to the oral microbiome, and we are positioned to be the authority on saliva testing for two audiences at once: our patients, and the physicians who increasingly recognize the mouth-body connection but have no training in oral diagnostics. That second audience is already in motion. As oral-systemic and functional medicine grow, more physicians are asking patients to establish care with a dentist who tests, because they want the data and cannot generate it themselves. If dentists do not occupy that role, it defaults to direct-to-consumer labs and to medical colleagues working without our expertise.

Starting is straightforward, and it can begin in-office this quarter. A chairside aMMP-8 screen takes five minutes and flags active breakdown on the spot. A clinician-ordered microbial panel establishes the bacterial baseline, guides therapy, and, on retest, measures the response. Together they turn periodontal care from a reactive cycle into a monitored, personalized one: screen, baseline, treat, retest, adjust. That is precision dentistry in practice rather than as a slogan, and it produces objective data you can show patients and share with their physicians.

Be honest about the boundaries, because honesty is what makes you the credible source. Microbial perio testing is well supported. aMMP-8 is a screening tool, not a diagnosis. HPV detection is a risk-awareness tool, not a screen. Consumer microbiome reports need interpretation, not endorsement. Hold those distinctions, and you become the authority rather than another voice overselling.

The fluid is already in the chair. The tests are validated for the applications dentistry cares about most. The future of personalized, wellness-centered dental care does not require new technology. It requires dentists willing to pick up the tools that already exist.

Disclosure: The author has no financial relationship, affiliation, ownership interest, or commercial arrangement with OralDNA, Simply Perio/Spectrum, Bristle, Viome, or any other saliva testing company referenced in this article. OralDNA is used in the author’s clinical practice as a paying customer only.

References
1. Salivary biomarkers as key to monitor personalized oral healthcare and precision dentistry: a scoping review. Front Oral Health. 2022.
2. Giannobile WV, McDevitt JT, Niedbala RS, Malamud D. Translational and clinical applications of salivary diagnostics. Adv Dent Res. 2011;23(4):375-380. PMID: 21917748.
3. Wong DT. Salivary diagnostics. Oper Dent. 2012;37(6):562-570. PMID: 22788724.
4. Evaluation of Salivary Diagnostics: Applications, Benefits, Challenges, and Future Prospects in Dental and Systemic Disease Detection. 2025. PMC11830415.
5. Salivary Diagnostics: Bridging Dentistry and Medicine. A Systematic Review. 2024. PMC11993397.
6. Quantitative PCR analysis of salivary periodontal pathogen burden in periodontitis (Parogene cohort, n=462). PMC4589666.
7. OralDNA Labs. MyPerioPath and MyPerioProgress test information. oraldna.com.
8. Salivary Molecular Testing for Periodontal Pathogen Monitoring: Clinical Performance of Flexible RT-PCR Platforms in Preventive Care Settings. Diagnostics (Basel). 2025. PMID: 41095767.
9. Active Matrix Metalloproteinase-8 (aMMP-8) Versus Total MMP-8 in Periodontal and Peri-Implant Disease Point-of-Care Diagnostics. Biomedicines. 2023. PMC10669684.
10. Lahteenmaki H, et al. aMMP-8 Point-of-Care/Chairside Oral Fluid Technology as a Rapid, Non-Invasive Tool for Periodontitis and Peri-Implantitis Screening in a Medical Care Setting. Diagnostics (Basel). 2020;10(8):562. PMID: 32764436.
11. Evaluation of active matrix metalloproteinase-8 (aMMP-8) chair-side test as a diagnostic biomarker in the staging of periodontal diseases. 2021. PMID: 33556789.
12. Saliva testing for human papillomavirus in oropharyngeal squamous cell carcinoma: a diagnostic accuracy study. 2017. PMID: 28620984.
13. Sensitivity and specificity of oral HPV detection for HPV-positive head and neck cancer. PMC5788034.
14. Diagnostic applications of saliva in dentistry: sialometry and caries-activity assessment. PMC4086572.
15. Evaluating the Analytical Performance of Direct-to-Consumer Microbiome Testing Services. 2024 (preprint, bioRxiv 2024.06.05.596628).

Dr. Katie To is a practicing dentist with a focus on restorative, cosmetic, and prevention-oriented care. To is the founder of the Wellness Dentist Institute, an educational organization focused on whole-patient considerations in dental practice. Her clinical interests include the oral-systemic connection, risk-based treatment planning, and interdisciplinary collaboration. She has completed advanced training in biological dentistry and digital smile design and lectures on integrating these concepts into everyday dental care.