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Diagnostics 2018, 8(3), 67;

Diagnosis of Newly Delivered Mothers for Periodontitis with a Novel Oral-Rinse aMMP-8 Point-of-Care Test in a Rural Malawian Population

Department of Periodontology and Geriatric Dentistry, University of Oulu, Oulu 90014, Finland
Center for Child Health Research, University of Tampere, Tampere 33014, Finland
Medical Imaging Centre, Department of Radiology, Tampere University Hospital, Tampere 33521, Finland
College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre, Malawi
Laboratory of Periodontal Biology and Department of Pathology and Oral Medicine, Faculty of Dentistry, Universidad de Chile, Av. Sergio Livingstone Polhammer 943, Independencia, Santiago 8380492, Chile
Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Stenbäckinkatu 9, PO BOX 100, Helsinki 00029, Finland
Department of Dentistry and Oral Health, Aarhus University, Faculty of Health Sciences Aarhus University Vennelyst Boulevard 9, Aarhus 8000, Denmark
Department of Paediatrics, Tampere University Hospital Central Hospital PO BOX 2000, Tampere 33521, Finland
Institute for Molecular Diagnostics (IMOD), Bonner Str. 84, Solingen 42697, Germany
Division of Periodontology, Department of Dental Medicine, Karolinska Institute, Stockholm SE-171 77, Sweden
Author to whom correspondence should be addressed.
Received: 1 August 2018 / Revised: 7 September 2018 / Accepted: 12 September 2018 / Published: 15 September 2018
(This article belongs to the Special Issue Novel Point-of-Care Technologies in Diagnostics 2018)
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A novel qualitative point-of-care test of activated matrix metalloproteinase-8 (aMMP-8) using noninvasive oral rinse sampling procedures has been developed for the early detection of collagen breakdown indicating periodontal tissue destruction. The main object of this study was to assess the reliability of the test in a low-income setting to identify participants with history of periodontal destruction detected as alveolar bone loss (ABL) in radiographs. This cross-sectional study included 486 women who had recently delivered in rural Malawi. The aMMP-8 test and dental panoramic radiographs were taken within 48 h of delivery. The performance of the test in comparison to radiological examinations was tested by following the standards for reporting of diagnostic accuracy studies protocol (STARD) with respective statistical measures and 95% confidence intervals. From the 486 eligible participants, 461 mothers with complete data, aged from 15 to 46 years (mean 24.8, SD 6.0) were included in the analysis. ABL was identified in 116 of 461 participants. There was 56% agreement between the aMMP-8 test results and detected ABL (yes or no) in radiographs. Calculated sensitivity of the test was 80% (72–87%), specificity 48% (43–54%), positive predictive value 34% (31–37%), negative predictive value 88% (83–91%), positive likelihood ratio 1.55 (1.35–1.77), and negative likelihood ratio 0.41(0.28–0.60). The aMMP-8 test sensitivity and negative predictive value to identify the ABL cases were relatively high, but there was additionally a high rate of test-positive results in participants without ABL, especially in young mothers, leading to low overall agreement between the test results and radiological bone loss. Further longitudinal studies are needed to examine if the test positive subjects are in risk of future bone loss before the detectable signs of periodontitis in radiographs. View Full-Text
Keywords: alveolar bone loss; matrix metalloproteinase (MMP)-8; periapical infection; periodontitis; point-of-care testing; saliva alveolar bone loss; matrix metalloproteinase (MMP)-8; periapical infection; periodontitis; point-of-care testing; saliva

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Leppilahti, J.M.; Harjunmaa, U.; Järnstedt, J.; Mangani, C.; Hernández, M.; Tervahartiala, T.; Lopez, R.; Ashorn, U.; Ashorn, P.; Gieselmann, D.-R.; Sorsa, T. Diagnosis of Newly Delivered Mothers for Periodontitis with a Novel Oral-Rinse aMMP-8 Point-of-Care Test in a Rural Malawian Population. Diagnostics 2018, 8, 67.

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