Author: Thomas W. Nabors, DDS:
The Founder of Salivary Diagnostics Within the Oral Systemic Communities
Salivary diagnostics has become the gold standard for a definitive diagnosis for causative agents for inflammatory diseases that we call periodontal infections: Plus, the specific microorganisms that cause dysfunctional systemic inflammation that leads to alveolar bone loss as well as the most important link to other inflammatory diseases.
My Journey Into Oral Microbiology
My journey into oral microbiology began in a small Mississippi practice in the late 1970s. After twelve years of general dentistry, I called a meeting with my hygiene team one morning and proposed that we either stop treating periodontal disease entirely or refer everyone out. Everything else I did had a high predictability rate of success. Treating periodontal infections did not.
That frustration sent me into the literature. Around 1980, I began studying oral microbiology, and I have continued for the past forty-five years. In the early years we had only phase-contrast microscopy — useful for distinguishing healthy mouths from infected ones, but not specific enough to identify the microorganisms driving dysbiosis. The Forsyth Institute’s ten-year trial from 1994 to 2004 changed that, identifying what we now call the keystone pathogens.
In the 1990s, looking for technology that would let dentists actually identify these organisms, I traveled to Germany to learn DNA-PCR, which our physician colleagues were already using in infectious disease. While there I met Dr. Peter Kemp, who had adapted DNA-PCR for oral medicine.
In 2003, along with my son Thomas Nabors, III, DDS, we reviewed the scientific literature that inspired us to create the first clinical laboratory in the U.S. using only saliva for this type of information, diagnosis, and treatment planning. While we eventually sold our lab, there are now several clinical laboratories that have followed our lead in recognizing this important “missing link” within oral medicine.
Why This Work Matters
There is good reason to take this work seriously. A review of five separate university studies found that only nine percent of patients treated with scaling and root planing are completely healthy at the five-year mark. Most hygienists will not be surprised by that number. If our crown-and-bridge or our implants failed at that rate, we would find another way.
However, no lab until today has created the most informative test like the OraPath Balance Test. Most other labs are using outdated data and are making testing much too difficult and expensive.
So, in 2003, we focused on those oral pathogens that had the most abundant literature reviews that defined the causative agents of periodontal infections based upon microbial dysbiosis. These microbial pathogens were defined as the most important markers. And, when detected, were designed to create a focused or Targeted Treatment Strategy based purely upon oral pathogens. At that time, literature did not focus much on those microorganisms in the mouth that supported health.
In looking at more than forty thousand case samples over the years, I have come to a view that runs counter to much of the field’s current focus. We hear a great deal about Porphyromonas gingivalis, and rightly so. But Aggregatibacter actinomycetemcomitans is, in my experience, by far the most pathogenic of the organisms we measure. It is typically not found in healthy mouths, and where it is present in healthy individuals, it appears in extremely small numbers.
The Science Behind the Test
This points to something I believe we still under-appreciate as a profession. Periodontal disease is fundamentally an immunological disease. The microorganisms are the trigger, but the destruction of attachment and bone is the immune system’s response to that trigger. Aa and Pg together produce what is now called “trained immunity” — they retrain the innate and adaptive systems to keep the immune response activated continuously, producing the long-term tissue destruction we see clinically. Saving teeth through mechanical hygiene is not the same as resolving that immune activation.
Along the way, literature began to change based upon a newer understanding of how the oral microbiome remains balanced or regains balance.
Today, in 2026, the literature has focused upon both:
- Causative agents for oral dysbiosis, teeth / implant infections, & systemic inflammation
- Health associated microorganisms that support the nitrate reduction cycle called The Entero-Salivary Nitrate Reduction Cycle.
Building the Balance Test
Several months ago, as a consultant, I introduced the idea for creating a salivary diagnostic test that examined both oral pathogens as well as oral nitrate reducing species.
The goals of this test are very simple:
- Reduce the oral pathogens to host acceptable levels: this provides an extra and essential opportunity for health associated microbes to grow.
- Increase the nitrate reducers to higher levels: this helps to prevent the return of oral pathogens.
The principle is simple: eliminate the bad and increase the good.
Getting Started
If you are not yet testing, start. You do not have to know everything to begin. OraPath’s training program, led by Julie Cox, BSDH, RDH, EFDA, is built to coach clinicians from the first test forward.
A few things I would ask you to consider as you do:
Give your hygienists the time. They want to do this work. The most common reason testing programs fail in a practice is that hygienists are asked to integrate testing within the same appointment time they had before.
Keep testing simple and affordable. Do not see the test itself as a profit machine. I gave away many tests in my own practice — ethically moving long-standing prophy patients into appropriate periodontal treatment was worth more than any single test fee.
Use the test to educate, both your patients and yourself. Show the report. Make the invisible visible.
Document your cases. The before-and-after is what convinces colleagues, builds patient trust, and trains the next generation of clinicians in your practice.
My best wishes in your journey as health care professionals.
Tom