Salivary Biomarkers for Early Detection of Type 2 Diabetes Mellitus in General Dentistry Practices
Keywords:
salivary biomarkers, type 2 diabetes mellitus, dental practice, opportunistic screening, periodontal disease, HbA1cAbstract
Type 2 diabetes mellitus (T2DM) remains substantially underdiagnosed, and general dental practices represent an underused opportunistic screening setting. This cross-sectional study evaluated non-invasive salivary biomarkers for identifying undiagnosed T2DM and prediabetes among adult dental patients. A total of 180 participants were stratified into three groups based on HbA1c and medical history: healthy controls (n=60), prediabetes (n=55), and confirmed T2DM (n=65). Unstimulated whole saliva was analyzed for salivary glucose, alpha-amylase, MMP-8, flow rate, and pH, alongside full periodontal examination, with venous HbA1c as reference standard. Salivary glucose increased progressively across groups (HC 0.28, prediabetes 0.52, T2DM 0.89 mmol/L; p<0.001) and correlated strongly with HbA1c (r=0.81, p<0.001). MMP-8 and periodontal parameters were also significantly elevated in T2DM group. ROC analysis showed salivary glucose alone achieved AUC 0.86 (sensitivity 81%, specificity 79%) for distinguishing dysglycemic from normoglycemic individuals, while combined biomarker panel (glucose, amylase, MMP-8) improved performance to AUC 0.91 (sensitivity 88%, specificity 84%). These findings support the feasibility of chairside salivary biomarker testing as an adjunctive, non-invasive opportunistic screening tool for undiagnosed T2DM and prediabetes within general dental practices, with potential to facilitate earlier medical referral and interprofessional collaborative care.
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