Diagnostic accuracy of aMMP-8 levels in oral biofluids for monitoring periodontitis in patients with metabolic syndrome

Abstract Objectives The increasing prevalence of metabolic syndrome (MetS) and periodontitis, both marked by chronic inflammation that disrupts immune function, underscores the need for tailored healthcare approaches that account for their systemic inflammatory impact. The study aimed to estimate and compare the diagnostic accuracy of aMMP-8 expression in oral rinse, saliva, and GCF (gingival crevicular fluid) among patients with periodontitis and those with and without MetS. Materials and methods A pilot sample of 77 participants was categorized into three groups based on the 2018 AAP/EFP periodontitis classification and the 2006 IDF metabolic syndrome criteria: MetS with periodontitis (MetS-PD; n = 34), systemically healthy with periodontitis (SH-PD; n = 21), and healthy controls (SH-PH; n = 22). Active metalloproteinase-8 (aMMP-8) levels in oral biofluids were quantified using an enzyme-linked immunosorbent assay. ANOVA and ROC curve analysis were done to assess diagnostic accuracy across groups. Results aMMP-8 levels varied by group but remained consistent across biofluids, with lower levels in SH-PH and higher levels in SH-PD and MetS-PD ( p < 0.001). aMMP-8 levels were significantly elevated in MetS-PD (25.86 ± 4.48 ng/ml) and SH-PD (24.72 ± 2.13 ng/ml) compared to controls (11.99 ± 3.46 ng/ml) in oral rinse samples ( p < 0.001). Oral rinse demonstrated superior diagnostic accuracy (AUC = 0.89) compared to saliva (AUC = 0.85) and GCF (AUC = 0.82) in distinguishing MetS-PD from healthy controls, with an optimal cut-off value of 20 ng/ml. Conclusion Oral rinse may be a preferable matrix for diagnosing periodontal disease, particularly in patients with systemic conditions, compared to saliva and GCF. Prospective longitudinal studies are required to evaluate its utility for monitoring over time. Clinical relevance This study highlights the potential of aMMP-8 as a reliable biomarker for assessing periodontal disease severity in patients with MetS, utilizing non-invasive oral fluids. With oral rinses demonstrating high diagnostic accuracy, they may be an effective and accessible tool for screening and case-finding in medical and dental settings in patients with MetS, facilitating early detection and tailored management strategies. aMMP-8 immunoassay chair-side kit offers a practical alternative to traditional methods for screening patients in non-dental settings.