Nicole Forel | General Dentist

“That’s not to say that I don’t admire the potential there, because obviously the idea of being able to identify the patients who are going to be susceptible to periodontal disease is a Holy Grail for our specialty,” he says. “One of the questions that’s raised in my mind is, even after I’ve identified a susceptible patient, aside from perhaps wanting to see that patient more frequently, what would I do differently?”

However, dentists such as Bauman and James Kassolis of the Towson Center for Dental Implants and Periodontics say test results are already influencing their approach to treatment.

“The patient just rinses with a saline solution, spits into a tube, and we send it to a lab. They test for 11 different bacteria,” explains Bauman. “I have a patient who has terrible periodontal disease, and she was over the threshold for eight of the bacteria. So we can scale her teeth and clean underneath the gums, but if we don’t do something to get rid of those bacteria, the disease will never be under control. So, with this patient, we’ll use a laser to get into pockets and sterilize them. We’ll get her on a course of antibiotics to get those bacteria out.”

Kassolis agrees. “The specificity of the tests is at a level where we can definitely differentiate between the types of pathogens and the severity of the disease,” he says. “We need the testing for us to be effective, as far as what we’re doing and the result we’re getting.”

Because salivary DNA testing is still being studied, it is not commonly covered by insurance. At the Baltimore Center for Advanced Dentistry, the typical out-of-pocket cost for patients is $150, says Bauman. On the other side of the cost-benefit scale, however, salivary DNA testing could have considerable advantages for patients even beyond the treatment of periodontal disease.

“There is a direct correlation between periodontal disease and heart disease,” says Kassolis. “The same bacteria that cause periodontal disease cause plaque formation in the arteries of the heart.” He adds that periodontal disease is similarly linked with diabetes, and perhaps even with early onset pancreatic cancer.

So what if salivary testing could alert patients to the possibility that they are also suffering from these other conditions?

Again, UMD’s Shiau urges caution. “There’s the potential to misinterpret the findings without proper genetic counseling,” he says. “The fear is that it can generate undue anxiety in patients.”

But DNA testing at your dentist’s office could serve as the first step in further evaluation, Bauman notes. And it could catch patients who see their dentist every six months but may not have seen their family physician in years.

“We can tell you’re at high risk for heart disease, even though your blood values aren’t showing it yet, or you’re pre-diabetic,” he says. “Then maybe we can refer the patient to a physician to treat it. The oral DNA testing we have right now is just the very tip of the iceberg in terms of what dentists will be responsible for.”