Urine, Blood and Salivary Tests That Bridge Medical-Dental Collaboration

Let’s dive into how these leading indicator tests can signal an urgent need for interdisciplinary care and why this collaboration is essential for the best patient outcomes.

Exam: Oral or Oral/systemic?

• If a patient has a bloody prophy, oral bacteria are mixing with the patient’s blood and lymphatic system, and they should be referred to establish care with an enlightened physician who is prepared to further investigate with blood and urine tests and radiology imaging to determine if systemic inflammation, infection or atherosclerosis is connected to their oral health. 
• If a patient is a mouth breather, snores, or has a Mallampati score of 3 or 4, referral for a sleep test to rule out sleep disordered breathing is suggested.
  

Blood Tests: The Red Flags for Collaboration

Serum markers tests are a cornerstone of medical diagnostics, patients are accustomed to using actionable data from blood tests, and serum biomarkers can point directly to oral health issues that require dental intervention. Here are some key examples:

• C-Reactive Protein (CRP): Elevated CRP levels are a marker of systemic inflammation. While CRP can be elevated due to various conditions, including cardiovascular disease and autoimmune disorders, it is also strongly associated with periodontal disease. If a patient presents with persistently high CRP levels with no obvious medical causes, it’s time to investigate their oral health. Periodontal infections can function as a chronic source of inflammation, driving up CRP levels and increasing the risk of heart attacks and strokes. Medical/Dental collaboration to address gum disease can significantly reduce systemic inflammation and improve overall health.
• Myeloperoxidase (MPO): MPO which used in cardiology to identify vulnerable atherosclerotic plaque is an inflammatory marker that can also indicate endodontic infections. These infections often go unnoticed during routine dental exams but can be found through advanced imaging techniques like cone beam CT scans. If a patient has elevated MPO levels, it’s a red flag for potential dental pathology. A medical professional should refer the patient with the combination of high hsCRP plus high MPO to a dentist trained in oral-systemic health to find and treat the underlying infection.
• Lipoprotein-Associated Phospholipase A2 (Lp-PLA2): This enzyme, made by aggravated white blood cells is a marker of vascular inflammation, but is often elevated in patients with periodontal disease. Like CRP and MPO, elevated Lp-PLA2 levels warrant a closer look at the patient’s oral health. Addressing periodontal infections can help lower this marker and reduce the risk of cardiovascular events.
• Galectin-3: Galectin-3 is a biomarker associated with tissue fibrosis and chronic inflammation. While cardiologists see this marker increase when heart muscle in remodeling in heart failure, elevated levels can indicate osteonecrosis of the jaw, a condition often linked to bisphosphonate use or untreated dental and tooth root infections. This is also seen when osteonecrosis involves third molar sites, even decades after wisdom tooth extraction, especially if the periodontal ligament was not completely removed. Collaboration between medical and dental professionals is crucial for diagnosing and managing this condition effectively.
• Vitamin D and CoQ10 Levels: Deficiencies in these nutrients are common in patients with periodontal disease. Vitamin D plays a critical role in bone health, while CoQ10 is essential for gum health. Naming and addressing these deficiencies through medical and dental collaboration can significantly improve oral and systemic health.

Salivary Tests: The Window to Oral and Systemic Health

Salivary diagnostics are an emerging field that offers a non-invasive way to assess both oral and systemic health. Saliva contains biomarkers that can reveal infections, inflammation, and even genetic predispositions to clinical response. Here are key salivary tests that highlight the need for medical-dental collaboration:

• Pathogen Testing: Salivary tests can identify specific bacteria associated with periodontal disease, such as Porphyromonas gingivalis and Treponema denticola. These pathogens are not only harmful to oral health but are also linked to systemic conditions like cardiovascular disease, diabetes, and Alzheimer’s disease. Pg not only makes gingipains (a virulent protease), it also secretes dihydroceramide—i.e. it makes its own plaque – devastating to brains and blood vessels. If a salivary test reveals elevated levels of these bacteria, it’s a clear signal for medical and dental professionals to work together to address the infection and its systemic implications.
• Inflammatory Markers: Saliva can be assessed for inflammatory markers like interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-α). Elevated levels of these markers indicate active inflammation, often due to periodontal disease. Medical professionals should collaborate with dentists to treat the underlying cause and reduce systemic inflammation.

Urine Tests: The Underestimated Ally

While urine tests are often associated with kidney function and metabolic health, they can also provide valuable insights into oral-systemic connections. Here is how:

• Markers of Oxidative Stress: Urine tests can measure oxidative stress markers like F2-isoprostane or 8-hydroxy-2'-deoxyguanosine (8-OHdG). Elevated levels indicate increased oxidative damage, which can be linked to chronic infections, including periodontal disease. Addressing the source of oxidative stress through dental care can help reduce these markers and improve overall health.
• Calcium and Phosphorus Levels: Imbalances in these minerals can indicate bone loss, which may be related to periodontal disease or other dental conditions. A urine test revealing abnormal calcium or phosphorus levels should prompt a dental evaluation to assess bone health and prevent further complications.
• Heavy Metal Testing: Urine tests can also detect heavy metals like mercury and lead, which can accumulate from dental amalgams or environmental exposure. Elevated levels of these metals can have systemic effects, including neurological and cardiovascular issues. Collaboration between medical and dental professionals is essential for safely addressing heavy metal toxicity.

The Case for Collaboration

The data is clear: persistent inflammation is at the root of medical evil, and often, the root cause is found in the gums and the roots of the teeth. Without a partnership between medical and dental professionals, we cannot achieve optimal health for our patients. Here’s why collaboration is so crucial:

• Comprehensive Care: Many chronic conditions, such as cardiovascular disease, diabetes, and autoimmune disorders, have oral health components. By working together, medical and dental professionals can address the root causes of these conditions rather than just managing symptoms.
• Early Detection: Diagnostic tests often reveal subclinical conditions—issues that are not yet causing symptoms but have the potential to progress into serious health problems. Early intervention through medical-dental collaboration can prevent these conditions from worsening. Often the first symptom of a DENTAL problem is found in MEDICAL lab data and establishing open and frequent lines of communication is critical for patient success.
• Patient Education: Patients are more likely to take their health seriously when they see their medical and dental providers working together. This unified approach reinforces the importance of oral health in overall wellness and encourages patients to take proactive steps to improve their health.
• Improved Outcomes: Studies have shown that treating periodontal disease can improve glycemic control in diabetic patients, reduce the risk of cardiovascular events, and even lower systemic inflammation. These outcomes are only possible through collaboration between medical and dental professionals.

Conclusion

Urine, blood, and salivary tests are not just diagnostic tools, they are bridges that connect the worlds of medicine and dentistry. By recognizing the oral-systemic connections revealed through these tests, we can provide more comprehensive, effective care for our patients. Collaboration is not just beneficial, it is essential. Together, medical and dental professionals can transform patient outcomes, proving that the whole is indeed greater than the sum of its parts. We can bridge the gap and work together to create a healthier future for all.

References

Intro – Diagnostic Testing & Collaboration

Sanz M, Marco Del Castillo A, Jepsen S, Gonzalez‐Juanatey JR, D’Aiuto F, Bouchard P, et al. Scientific evidence on the links between periodontal diseases and systemic non-communicable diseases: A consensus report. J Clin Periodontol. 2020;47(S22):16–17.  doi: 10.1111/jcpe.12808.

CRP and Periodontal Disease

Paraskevas S, Huizinga JD, Loos BG. The effect of periodontal therapy on C-reactive protein: A systematic review and meta-analysis. J Clin Periodontol. 2008;35(4):277–290. doi:10.1111/j.1600-051X.2007.01173.x

MPO and Endodontic Infections

Gomes MS, Blattner TC, Sant’Ana Filho M, Grecca FS, Hugo FN, Fouad AF, et al. Myeloperoxidase in dental and medical conditions. Arch Oral Biol. 2013;58(6):560–566. doi:10.1016/j.archoralbio.2013.01.017

Lp-PLA2 and Periodontal/Vascular Inflammation

Hasturk H, Kantarci A, Van Dyke TE. Role of inflammation in the pathogenesis of atherosclerosis: focus on periodontal disease. J Periodontol. 2012;83(4 Suppl):S15–S22. doi:10.1902/jop.2011.110462

Galectin-3 and Osteonecrosis/Heart Remodeling

De Martinis M, Sirufo MM, Ginaldi L. Galectin-3: A new marker of cardiovascular disease. Int J Mol Sci. 2020;21(14):5145. doi:10.3390/ijms21145145

Zerrin Barut et al, The role of salivary galectin-3 and galectin-9 levels in plaque-induced gingivitis and periodontitis, Heliyon, Volume 9, Issue 9, 2023, doi.org/10.1016/j.heliyon.2023.e19979.

Vitamin D and CoQ10 in Periodontal Disease

Varela-López A, Giampieri F, Bullón P, Battino M, Sánchez-González C, Quiles JL. Vitamin D, Coenzyme Q10, and omega-3 fatty acids in periodontal health. J Periodontal Res. 2016;51(6):743–752. doi:10.1111/jre.12357

Salivary Pathogen Testing (Pg, Td) and Systemic Links

Dominy SS, Lynch C, Ermini F, Benedyk M, Marczyk A, Konradi A, et al. Porphyromonas gingivalis in Alzheimer’s disease brains: Evidence for disease causation and treatment with small-molecule inhibitors. Sci Adv. 2019;5(1):eaau3333. doi:10.1126/sciadv.aau3333

Salivary Inflammatory Markers (IL-1, TNF-α)

Torrungruang K, Jitpakdeebordin S, Charatkulangkun O, Gleebbua Y. Salivary IL-1β, IL-6 and TNF-α as biomarkers for periodontal disease severity. J Clin Periodontol. 2009;36(5):387–393. doi:10.1111/j.1600-051X.2009.01378.x

Urinary Oxidative Stress Markers

Tomofuji T, Ekuni D, Yamanaka R, Sanbe T, Irie K, Azuma T, et al. Periodontitis and increase in circulating oxidative stress. J Clin Periodontol. 2005;32(10):1041–1045. doi:10.1111/j.1600-051X.2005.00758.x

Urinary Calcium and Phosphorus – Bone Loss

Schroeder HE. Oral Structure Biology: Including Nervous Elements. Stuttgart: Thieme Medical Publishers; 1993.

Heavy Metals and Dental Amalgams

Geier DA, Kern JK, Geier MR. A prospective study of mercury toxicity biomarkers in autistic spectrum disorders. J Toxicol Environ Health A. 2010;73(19):1294–1300. doi:10.1080/15287394.2010.481273

Medical-Dental Collaboration Improves Outcomes