CLINICAL

Saliva testing's first real job may be converting perio

For years, saliva has been pitched as the next frontier in dental diagnostics. Now, some researchers think the frontier has arrived—and its first job may be getting patients to say yes to perio treatment.

What happened: Salivary testing is moving out of research and into operations thanks to breakthroughs in our ability to read what’s in our spit.

• Saliva contains a dense mix of potential biological signals, but extracting any information from it has been—until recently—expensive and slow. That’s changing, however, as advances in genomics and other fields have made it possible to quickly and affordably detect more of the biological markers transmitted in saliva. 

• A 2026 review, for example, highlighted advances in sensors that can allow providers to detect specific biomarkers from saliva samples without having to send anything to a lab.

The perio connection: Perio is becoming an early proving ground for salivary testing because of its potential to measure something conventional exams do not directly capture: active tissue breakdown.

• While traditional exams largely show the current condition of the periodontium and damage that has already occurred, salivary testing has the potential to show what’s happening in the mouth right now by measuring levels of an enzyme called aMMP-8 that’s involved in collagen degradation.

• The science still isn’t perfect, however. A 2025 meta-analysis found point-of-care aMMP-8 testing had moderate overall diagnostic accuracy and concluded saliva testing should supplement, not replace, a clinical exam.

Why it matters: In terms of deployment in the real world, salivary testing is still not standard for most practices, though there’s at least one good reason for DSOs to consider changing that: it appears to be an effective way to encourage more patients to accept perio treatment. 

• Delta Dental of Massachusetts tested that idea with Smile Generation by offering chairside aMMP-8 screening during regular exams at no additional out-of-pocket cost. Of the 1,600 people who underwent an assessment during a regular exam, 50% subsequently accepted a periodontal treatment plan when recommended by their provider.

• More than 400 patients in the Delta program were tested multiple times, and returning patients' aMMP-8 scores improved by more than 33% on average. One participating dentist argued that repeatedly showing patients an objective wellness score helped drive engagement and action.

What you can do: It’s up to DSOs to decide whether the potential for greater perio conversions justifies offering salivary testing at a price point patients will accept (or at no cost).

• The good news is DSOs are well positioned to do this—a pilot program measuring the impact of this run across 20 locations can generate more useful real-world evidence than a single practice could collect in years.

Zoom out: Perio may only be saliva's opening act. Researchers are studying salivary biomarkers for caries, xerostomia, diabetes, cardiovascular disease, neurodegenerative disease, and other conditions—some day, a visit to the dentist may include screening for all of that and more.