Monitoring and controlling oral endotoxin levels for disease prevention

In the second of three articles on the three winners of the EFP’s Innovation Award for Digital Solutions for Gum Health 2023, Perio Insight focuses on technology that would monitor and control oral endotoxin activity to enable personalised primary and secondary prevention of gum diseases and related systemic complications. Third-prize winner Svetislav Zaric, from King’s College London, UK, explains his innovation.


Most periodontal diseases develop insidiously, and it may take years for periodontitis to clinically manifest and to be diagnosed. So far, the diagnostic focus has been on determining the extent of the historical tissue breakdown – probing pocket depth (PPD) and clinical attachment loss (CAL) – rather than on detecting the biological start of the disease.

As periodontal diseases are episodic and site-specific in nature – with still-unknown factors that drive the progression from gingivitis to periodontitis – there are unique challenges in identifying and monitoring periodontal conditions. Different individuals demonstrate varying susceptibility to the onset and progression of periodontal diseases. Consequently, the application of uniform preventive and curative protocols will rarely meet individual needs, resulting in underprovision of care to some individuals and overprovision to others. This can lead to an increased disease burden, unwanted side effects, and the suboptimal allocation of resources, and so is an important issue for both primary and secondary prevention.

The provision of patient care guided by the assessment of patient-level and site-level risk for the development and progression of periodontitis may therefore be an advantageous approach. In order to determine the personalised, point-of-care treatment plan and to reduce healthcare costs and inequalities, there is a fundamental requirement for disease-specific biomarkers to distinguish progressive periodontitis from normal biological processes and to reveal hidden threats before the disease becomes clinically apparent.

The identification of patient-level and site-level biological signatures with the potential to highlight risk kinetics, to mark disease progression, to monitor health status, and to indicate treatment outcomes would be of significant clinical advantage. There is a need for the development of new, chair-side, point-of-time diagnostic tests that can detect the presence of active disease, predict future disease progression, and evaluate a patient’s response to periodontal therapy, thereby improving the clinical management of periodontal patients.

Moreover, epidemiological evidence accumulated over the last two decades suggests that periodontal diseases are associated with dyslipidaemia, glucose intolerance, hypertension, low-grade systemic inflammatory state, and with systemic diseases and conditions such as cardiovascular disease, diabetes, and obesity. Primary and secondary prevention of periodontal diseases is therefore important for alleviating the risk of these systemic complications and improving patients’ general wellbeing.