Absolutely. Smoking compromises immunity, circulation, etc., and therefore, smokers are more likely to have more periodontal issues and, thus, a higher Oral Fitness Score.

Yes! Orthopedic surgeons stress the importance of a healthy mouth before joint replacement surgery. Infection of the new orthopedic joint (appliance) is a very serious issue that could require more surgical procedures and long-term antibiotics. Since about 40% of seemingly clinically healthy patients test positive, we must be diligent about Oral Fitness testing to detect preclinical oral disease.

NO! It is designed to identify pre-clinical periodontal inflammation or collagen breakdown, as well as the activity of the process. It should be used in conjunction with an oral examination. OralFitnessCheck indicates the activity and breakdown of collagen and, importantly, provides visual confirmation to the patient regarding the need for further care. It is designed to identify patients who need more frequent prophylaxis and oral hygiene intensity, and it helps monitor post-periodontal treatment stability. Periodontal disease is diagnosed by identifying the previous destruction. In other words, retrospective evidence (bone loss and pocketing) and current extent and severity of destruction or loss of attachment. This includes probing, radiographs, bleeding on probing, etc.

No, it should be administered by anyone on the dental team. It provides results within 5 minutes.

It means ACTIVE inflammation or collagen breakdown is happening currently (real-time analysis). The higher the number, the greater the present activity or destruction.

Periodontal breakdown (collagenolysis) is episodic, like all chronic diseases. It depends on many factors, including the health of the patient’s immune system at that time.

There are sometimes other causes of oral collagen breakdown. This can occur with some systemic diseases like diabetes. Once a complete oral examination is performed to eliminate any other possible intraoral causes, it is time to refer the patient to a physician WITH communication.

Successful practices have done the following:

1. 1. Ensure the entire dental team understands the test and why we incorporate it into the practice.
   2. Implement a practice-wide program testing all patients over 14 years old.(Just like taking blood pressure every time in the physician’s office).
   3. Designate one or several team members to do the testing.
   4. Keep track of your results.
   5. After testing and examination, inform patients of the importance of the test and that you are doing this to keep them PHYSICALLY and dentally healthy. It is essential to detect breakdown before it starts and prevent inflammation from spreading from the mouth to other parts of the body.
   6. Share the test results with the patient and set individual
      goals for them to improve their score.

Research shows that oral inflammation and oral breakdown are connected to cardiac disease, diabetes, fertility, joint infections, some cancers, Alzheimer’s disease, arthritis, and other systemic diseases.

Studies show 40-50% of clinically healthy patients test positive. This means they are in the pre-clinical (invisible) stage of periodontal inflammatory breakdown (collagen breakdown). These patients should be scheduled for additional (more frequent) hygiene visits, additional oral hygiene instructions should be provided, and the patient should be tested again three months after the last prophylaxis.

After testing positive and having multiple hygiene visits with improved oral hygiene, the patient still has a positive OralFitness score. Discussing with the physician why you are sending the patient is very important. The dialogue may be: “We have worked on and improved the patient’s oral health, yet the patient still tests positive for oral inflammation and collagen breakdown (like C-reactive protein). We believe there is an underlying medical cause for this oral breakdown (e.g., Diabetes). Please perform a complete evaluation.” DO NOT just tell the patient to go to their physician!

This varies by practice. Most practices DO NOT charge for the first test. This works very well since 80% of the patients who test positive opt for further preventive care and more frequent recare visits. Clinical experience shows that hygiene and general practice revenues increase when implementing the testing program. The test cost is more than compensated for, and the barrier to patient acceptance is eliminated.

Since studies show that 40-50% of healthy patients (ones where there would be little or no revenue because they appear healthy) test positive, and then around 80% of those (and 47% of those with negative test results) accept additional hygiene services.

Clinical studies show hygiene revenues increase by more than 2.1 times in the EXISTING patient population, and general practice revenues also increased in non-hygiene areas. The average hygiene visits went from .96 to 2.3 visits per year. In addition to increasing revenue from existing patients, this testing service will generate new patient referrals because the patients tell others about the test and its value (of course, you must explain the medical and dental benefits to your patients).

If time allows, you can provide a more detailed explanation. They will explain to others how your practice uses modern biomarker technology and that the practice is concerned about their general health and oral health. Prevention!

It has a specificity of 95-100%. So, it is very accurate! The literature shows that there are no false positives.

Yes, very much so. Over 400 articles have been published in the dental literature. The medical literature contains approximately 1000 articles about MMP-8 and its function, value in diagnosis, and connection to diseases.

Bacteria testing merely identifies bacteria that are present. However, that does not mean they are causing breakdown! Disease progression requires both bacteria AND a breakdown of the patient’s immune defenses (that is why we see more periodontal and other diseases as people age since their immune defenses also decrease with age). The OralFitnessCheck measures the ACTIVE breakdown of the periodontal collagen structure in real-time. OralFitnessCheck gives a numerical test result and patient feedback within 5 minutes. In contrast, bacteria and genetic testing can take 1 to 2 weeks to obtain the results, requiring a second discussion and appointment with the patient. Also, the bacteria testing requires more time from staff for handling, mailing, etc.

Studies in the medical literature show significantly improved compliance in therapy, medication regains, and following practitioner direction utilizing the testing, regardless of the results.
The OralFitness test makes the invisible visible to the patient! POC testing increased patient satisfaction, facilitated the decision-making process, and increased adherence to physician recommendations from 24% to 85% (Al Hayek 2021).

Conditions such as:

• • Pericoronitis
  • Pemphigus Vulgaris
  • Lichen Planus
  • Tissue Trauma/Damage
  • Aphthous Ulcer
  • Systemic Diseases
  • Peri-implantitis
  • Salivary Inflammation

These will be identified in the clinical examination!

aMMP-8 is the active form of the enzyme MMP-8, demonstrating real-time activity level. MMP-8 is the cleaving enzyme for the breakdown of collagen. Therefore, it breaks down the collage barrier to allow the body’s defensive cells to resist a bacterial challenge in the subgingival area by allowing them to move from the bloodstream to the site of needed defense. aMMP-8 is always present, at a very low level, because it is involved in the normal turnover of tissues. There is an excessive breakdown at a high level (score above 10), as in the inflammatory process.

No, since aMMP-8 measures real-time collagen breakdown, the patient may be in a latent or non-active phase of collagenolysis. Like all chronic diseases, oral inflammation is episodic (Raisanen et al. 2018), and so is patient resistance. Pockets and radiographic bone loss are indicators of past activity (destruction).

Redness of the tissue can be present, but the metabolic process may not be active today. This means the patient’s immune system is healthy now so that any therapy would have a good result. Bleeding on probing can still be present because it takes time for the tissues to heal, and the subgingival lining may not have regenerated yet. The inflamed ulcerated subgingival surface area of periodontal disease can be the size of the palm of your hand. If there were a lesion or abrasion of this size on the skin, you would not expect it to heal in a few days but in weeks or longer.

aMMP-8 testing is not exactly specific for inflammation but active tissue destruction. While inflammation and active tissue destruction often coincide. It is shown that just because there are visible signs of inflammation does not necessarily mean active tissue breakdown is occurring, and just because there are no signs of inflammation does not mean no active tissue breakdown is occurring. The bleeding on probing scoring we use in dentistry is not accurate and predictive, as studies show.

The test is optimized for specificity (95-100%). So, if a patient has a positive result (elevated aMMP-8), periodontal tissue is actively being destroyed in the oral cavity. In general, low-risk screening tests such as OralFitnessCheck and COVID tests are optimized for specificity so that positive results can be used to act on! The entire pathogenic process of periodontal/peri-implant disease (levels of oral pathogens, host immune response, and tissue destruction) occurs in waves/cycles (episodic). Sometimes, when testing a patient, they can be in a quiescent phase of the cycle.

Some medications affect aMMP-8 levels, including Doxycycline/Tetracyclines, Cyclosporine, Bisphosphonates, Chlorhexidine, and Prednisone.

According to Hedenbjörk-Lager et al., extensive active caries can slightly increase aMMP-8 levels. However, an elevated score is likely more related to the patient’s poor oral hygiene.

An endodontic lesion is within the bone at the apex of a tooth. It generally has elevated levels of aMMP-8 in the bone that are likely not detectable via OralFitnessCheck.

While we as clinicians can diagnose EXISTING periodontal disease (by probing and taking radiographs that show past destruction), they cannot identify preclinical breakdown (about 40% of seemingly healthy patients) or know about the progression of periodontal breakdown. Also, our conventional diagnosis does not necessarily convince patients to accept treatment (they must believe what we tell them) or motivate them to focus on their daily oral hygiene adequately.