We appreciate the opportunity to discuss predictive diagnostics for periodontal diseases further than was possible in our original Primer (Periodontal diseases. Nat. Rev. Dis. Primers 3, 17038 (2017))1 by responding to the recent correspondence by Hernández and colleagues (A quantitative point-of-care test for periodontal and dental peri-implant diseases. Nat. Rev. Dis. Primers 3, 17069 (2017))2.

Quantitative diagnostic tests, such as the one the authors propose, which measures the levels of activated matrix metalloproteinase 8 (aMMP8) as a biomarker of active periodontal disease, are welcome new tools and could enhance screening for periodontal disease as well as aid diagnosis and prognostic assessment. However, more-extensive independent verification and a plausible biological argument that supports the role of the selected biomarker in the aetiopathogenesis of periodontal disease are needed before these tests can be recommended for clinical practice3. Molecular diagnostics in periodontal disease are to be encouraged, but not prematurely adopted, as occurred with the IL-1 genotype-based diagnostic test4–6. The IL-1-based genetic test was heavily marketed despite multiple studies that questioned its diagnostic utility3,4 and weak and contradictory elements in the supporting literature6. MMP8 is a ubiquitous inflammatory molecule, and inflammation contributes to both disease initiation and the healing process. Thus, aMMP8 would have a pivotal role in all phases of inflammation, which would hinder its predictive value3. Despite the many potential markers and tests that exist, only a few have verified clinical usefulness, and the Primer provides a balanced overview of those with proven utility or promise.

How to cite this article

Kinane, D. F., Stathopoulou, P. G. & Papapanou, P. N. Authors’ reply: Predictive diagnostic tests in periodontal diseases. Nat. Rev. Dis. Primers 3, 17070 (2017).