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    OraPath · Platform Reference

    Panels, scores, and reports in one place.

    OraPath is a qPCR-based oral-microbiome diagnostic platform. This reference summarizes the diagnostic panels, the scores and algorithms that interpret them, and the report formats available to providers and patients. Results are intended for use alongside a clinical examination and patient history.

    01

    Diagnostic panels

    Each panel measures a defined set of oral organisms from a single saliva specimen. Every organism is reported as a category — Not Detected, Trace, Low, Moderate, or High — alongside a Detection Level (DL) value.

    Essentials

    7 organisms

    The foundational periodontal panel: the six core gum-disease organisms plus total Fusobacterium nucleatum as an informational marker.

    Comprehensive

    15 organisms

    The full clinician panel: the core periodontal organisms plus bridging and early-colonizing species and a fungal marker, for a broader ecological picture.

    PerioCaries

    8 organisms

    Periodontal plus caries focus: the six core gum-disease organisms together with the two cavity-associated streptococci (S. mutans, S. sobrinus).

    Oral Balance Test

    16 organisms

    A balance-oriented panel grouped by function: protective nitric-oxide producers and commensal stabilizers alongside periodontal, cariogenic, and fungal organisms.

    02

    Scores & algorithms

    OraPath translates measured organism levels into a small set of interpretive scores. Each is semi-quantitative and pattern-based; the category and trend matter more than any single number. Scores support clinical interpretation — they do not replace it.

    Score / algorithmOutput & directionPanelsWhat it tells you
    Detection LevelDLCites · 5, 6, 39 0 – 30Higher = more organism measured
    Not DetectedTraceLowModerateHigh
    		 All panels The reporting unit for every organism, derived from the qPCR signal. Each result is shown as a category plus a DL value; the category is what matters most.
    Periodontal Risk ScorePRSCites · 1, 2, 4, 5, 7, 11–16, 18–24 1 – 5Higher = more advanced pattern Essentials · Comprehensive · PerioCaries A pattern-based classification of periodontal risk built from the six core gum-disease organisms. It reads the combination of organisms present, not just how much of any one is found.
    Periodontal Pressure ScorePPSCites · 1, 4, 7, 12, 20 0 – 100Higher = greater burden
    LowMildModerateElevatedSevere
    		 Essentials · Comprehensive · PerioCaries A continuous measure of combined periodontal-organism burden across the core six. It complements the PRS: where PRS names the pattern, PPS gauges how much pressure is present and how it may be trending over time.
    Caries (Cavity) RiskPerioCaries panelCites · 36–41
    MinimalLowModerateHigh
    		 PerioCaries A categorical cavity-risk readout derived from the two cavity-associated streptococci (S. mutans, S. sobrinus), reported alongside the periodontal scores.
    Oral Balance ScoreOBSCites · 1–5, 7, 9, 11–13, 17, 19–21, 23, 25, 40, 44, 45 0 – 100Higher = better balance
    Well BalancedMild ShiftImbalanced
    		 Oral Balance Test A single overall measure of how the oral microbiome is balanced — weighing protective communities against disease-associated ones. Built from the three component scores below.
    Protective Capacity ScorePCS · component of OBSCites · 9, 25–35 0 – 100Higher = stronger defenses Oral Balance Test The strength of the beneficial oral community — nitric-oxide producers and stabilizing commensals — that may help keep disruptive organisms in check.
    Disruptive Pressure ScoreDPS · component of OBSCites · 1, 4, 11–13, 17, 19–21, 23, 36, 37, 40, 44, 45 0 – 100Higher = more pressure Oral Balance Test The combined load of disease-associated organisms — periodontal, cariogenic, and fungal — that may push the microbiome out of balance.
    Nitric Oxide System ScoreNO · component of OBSCites · 25–31 0 – 100Higher = better capacity Oral Balance Test The capacity of nitrate-reducing oral bacteria to support the enterosalivary nitric-oxide pathway, which has been associated with cardiovascular and metabolic function.
    Bridging Burden ScoreBBSCites · 1, 3, 4, 8, 23, 46, 50 0 – 100Lower = better Comprehensive A measure of the orange-complex "bridging" organisms that can link early colonizers to later periodontal pathogens — part of the Comprehensive panel's ecological view.
    Ecological Patternnamed patternCites · 1, 3, 4, 8, 42, 43, 46–51 Named microbial signature Comprehensive One of several named patterns (for example bridging, early-colonizer, or fungal-overgrowth signatures) describing the overall shape of the microbial community detected.
    Antibiotic Considerationsdecision supportCites · 1, 4, 52–63 Clinician summary All panels (companion reports) An algorithm-assisted summary that surfaces allergy and contraindication flags and recognized options for the clinician to weigh. These reports are not stand-alone prescribing algorithms — they are intended to be interpreted by a qualified provider alongside the clinical exam and patient history.
    03

    Report formats

    Every panel can be delivered in the format that fits the reader — a clinician, a patient, or a specialist audience. Clinician and patient reports for the same specimen share the same underlying scoring, so they never show conflicting numbers.

    ReportAudienceWhat it includes
    Oral Balance Test family · 16-organism balance panel
    Provider ReportClinicianClinician-facing Oral Balance Test with focus areas, antibiotic considerations, and a prior-visit comparison when an eligible earlier visit exists.
    Patient ReportPatientDirect-to-consumer companion: OBS and nitric-oxide results, protective-vs-disruptive ecosystem pages, the full panel, and a "questions for your dentist" close.
    Oral Balance Patient Report (Provider)PatientPatient-friendly Oral Balance results for provider-initiated testing, closing with a provider-signed care plan instead of the DTC questions page.
    Oral Balance Antibiotic ReportClinicianAntibiotic-considerations companion for the Oral Balance Test, surfacing species-level susceptibility signals and considerations for the prescribing clinician.
    PerioCaries family · 8-organism perio + caries panel
    Perio-Caries ReportClinicianPerioCaries risk assessment combining periodontal and caries findings, with antibiotic considerations and a prior-visit comparison when available.
    PerioCaries Patient ReportPatientPatient-facing PerioCaries report adding a Cavity Risk element alongside periodontal risk and bacterial burden, with a two-group panel and a provider-signed care plan.
    Perio-Caries Antibiotic ReportClinicianAntibiotic-considerations companion scoped to the periodontal and cariogenic organisms on the PerioCaries panel.
    Essentials family · 7-organism periodontal panel
    Essentials ReportClinicianCore periodontal panel covering the foundational oral-health markers in the Detection Level format, with antibiotic considerations.
    Essentials Report (Legacy)ClinicianClassic copies/mL bar-chart view for providers who have not yet transitioned to the Detection Level format.
    Essentials Patient ReportPatientPatient-facing Essentials report at the seven-organism scope, with an informational Fusobacterium callout and a provider-signed care plan.
    Essentials Antibiotic ReportClinicianAntibiotic-considerations companion scoped to the Essentials panel markers.
    Comprehensive family · 15-organism full panel
    Comprehensive ReportClinicianFull clinician panel with the complete marker set, ecological profile, focus areas, antibiotic considerations, and a prior-visit comparison when available.
    Comprehensive Report (Legacy)ClinicianClassic copies/mL view of the full 15-organism panel for providers who have not yet transitioned to the Detection Level format.
    Comprehensive Patient ReportPatientPatient-facing full panel with periodontal risk and bacterial burden, ranked findings, data-gated oral-systemic associations with references, and a provider-signed care plan.
    Comprehensive Antibiotic ReportClinicianAntibiotic-considerations companion providing full-panel considerations across the complete Comprehensive marker set.
    04

    Citations

    The peer-reviewed evidence base behind the OraPath scores and algorithms, consolidated and de-duplicated across the platform's algorithm documentation and report references, and grouped by theme. The "Cites" tag on each score above maps to the numbered entries below.

    Foundational microbiome & ecology
    1. Socransky SS, Haffajee AD, Cugini MA, Smith C, Kent RL Jr. Microbial complexes in subgingival plaque. J Clin Periodontol. 1998;25(2):134–144.
    2. Socransky SS, Haffajee AD. Periodontal microbial ecology. Periodontol 2000. 2005;38:135–187.
    3. Marsh PD. Are dental diseases examples of ecological catastrophes? Microbiology. 2003;149(2):279–294.
    4. Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nat Rev Immunol. 2015;15(1):30–44.
    5. Lamont RJ, Koo H, Hajishengallis G. The oral microbiota: dynamic communities and host interactions. Nat Rev Microbiol. 2018;16:745–759.
    6. Kilian M, et al. The oral microbiome — an update for oral healthcare professionals. Clin Microbiol Infect. 2016;22:657–666.
    7. Kolenbrander PE, Palmer RJ Jr, Rickard AH, Jakubovics NS, Chalmers NI, Diaz PI. Bacterial interactions and successions during plaque development. Periodontol 2000. 2006;42:47–79.
    8. Kolenbrander PE, Palmer RJ Jr, Periasamy S, Jakubovics NS. Oral multispecies biofilm development and the key role of cell-cell distance. Nat Rev Microbiol. 2010;8(7):471–480.
    9. Rosier BT, et al. Resilience of the oral microbiota in health. J Dent Res. 2018;97:371–380.
    10. Slots J. Human viruses in periodontitis. Periodontol 2000. 2010;53:89–110.
    Periodontal pathogens
    1. Darveau RP, Hajishengallis G, Curtis MA. Porphyromonas gingivalis as a potential community activist for disease. J Dent Res. 2012;91(9):816–820.
    2. Fine DH, Schreiner H, Velusamy S, et al. Aggregatibacter actinomycetemcomitans (Aa) under the radar. Front Immunol. 2019;10:728.
    3. Belibasakis GN, Maula T, Bao K, et al. Virulence and pathogenicity properties of Aggregatibacter actinomycetemcomitans. Pathogens. 2019;8(4):222.
    4. Henderson B, Ward JM, Ready D. Aggregatibacter (Actinobacillus) actinomycetemcomitans: a triple A* periodontopathogen? Periodontol 2000. 2010;54(1):78–105.
    5. Åberg CH, Kelk P, Johansson A. Aggregatibacter actinomycetemcomitans: virulence of its leukotoxin and association with aggressive periodontitis. Virulence. 2015;6(3):188–195.
    6. Sharma A. Virulence mechanisms of Tannerella forsythia. Periodontol 2000. 2010;54(1):106–116.
    7. Ng HM, Kin LX, Dashper SG, et al. The role of Treponema denticola motility in synergistic biofilm formation with Porphyromonas gingivalis. Front Cell Infect Microbiol. 2019;9:432.
    8. Ng HM, Kin LX, Dashper SG, et al. Bacterial interactions in pathogenic subgingival plaque. Microb Pathog. 2019;119:153–162.
    9. Zhu Y, Dashper SG, Chen YY, et al. Porphyromonas gingivalis and Treponema denticola exhibit metabolic symbioses. PLOS ONE. 2013;8(8):e71727.
    10. Aruni AW, Dou Y, Mishra A, Fletcher HM. Filifactor alocis — a new emerging periodontal pathogen. Microbes Infect. 2015;17(7):517–530.
    11. Aja E, Mangar M, Fletcher HM, Mishra A. Filifactor alocis: recent insights and advances. Pathogens. 2021;10(7):790.
    12. Schlafer S, Riep B, Griffen AL, et al. Filifactor alocis — involvement in periodontal biofilms. BMC Microbiol. 2010;10:66.
    13. Han YW. Fusobacterium nucleatum: a commensal-turned pathogen. Curr Opin Microbiol. 2015;23:141–147.
    14. Chen Y, Chen Y, Cao P, Su W, Zhan N, Dong W. Fusobacterium nucleatum: the opportunistic pathogen of the oral and intestinal tract. Front Cell Infect Microbiol. 2022;12:815318.
    Nitric oxide & nitrate metabolism
    1. Rosier BT, Takahashi N, Zaura E, Krom BP, Marsh PD. The importance of nitrate reduction for oral health. J Dent Res. 2022;101(8):887–897.
    2. Hyde ER, Andrade F, Vaksman Z, et al. Metagenomic analysis of nitrate-reducing bacteria in the oral cavity. PLOS ONE. 2014;9(3):e88645.
    3. Rosier BT, Moya-Gonzalvez EM, Corell-Escuin P, et al. Nitrate reduction capacity of the oral microbiota is impaired in periodontitis. Int J Oral Sci. 2024;16:3.
    4. Vanhatalo A, Blackwell JR, L’Heureux JE, et al. Nitrate-responsive oral microbiome modulates nitric oxide homeostasis and blood pressure in humans. Free Radic Biol Med. 2018;124:21–30.
    5. Doel JJ, Benjamin N, Hector MP, Rogers M, Allaker RP. Evaluation of bacterial nitrate reduction in the human oral cavity. Eur J Oral Sci. 2005;113(1):14–19.
    6. Rosier BT, et al. Nitrate as a potential prebiotic for the oral microbiome. ISME J. 2020;14:2459–2469.
    7. Hezel MP, Weitzberg E. The oral microbiome and nitric oxide homeostasis. Free Radic Biol Med. 2015;105:48–57.
    Commensal & protective community
    1. Kreth J, Zhang Y, Herzberg MC. Streptococcal antagonism in oral biofilms. J Bacteriol. 2008;190(13):4632–4640.
    2. Abranches J, Zeng L, Kajfasz JK, et al. Biology of oral streptococci. Microbiol Spectr. 2018;6(5).
    3. MacDonald KW, Chanyi RM, Macklaim JM, et al. Streptococcus salivarius inhibits immune activation by periodontal disease pathogens. BMC Oral Health. 2021;21:245.
    4. Beattie RE, Walsh EM, Ghaffar A, et al. Probiotics for oral health: a critical evaluation of bacterial strains. Front Microbiol. 2024;15:1430810.
    Caries & cariogenic organisms
    1. Loesche WJ. Role of Streptococcus mutans in human dental decay. Microbiol Rev. 1986;50(4):353–380.
    2. Sánchez-Acedo M, Montiel-Company JM, Dasí-Fernández F, Almerich-Silla JM. Streptococcus mutans and Streptococcus sobrinus detection by polymerase chain reaction and their association with dental caries. Med Oral Patol Oral Cir Bucal. 2013;18(6):e839–e845.
    3. Saraithong P, Pattanaporn K, Chen Z, et al. Streptococcus mutans and Streptococcus sobrinus colonization and caries experience in 3- and 5-year-old Thai children. Clin Oral Investig. 2015;19(8):1955–1964.
    4. Childers NK, Osgood RC, Hsu KL, et al. Real-time qPCR for quantification of S. mutans and S. sobrinus in dental plaque samples. J Microbiol Methods. 2011;86(3):290–296.
    5. Takahashi N, Nyvad B. The role of bacteria in the caries process: ecological perspectives. J Dent Res. 2011;90(3):294–303.
    6. Featherstone JDB. The caries balance: the basis for caries management by risk assessment. Oral Health Prev Dent. 2004;2(Suppl 1):259–264.
    Cross-kingdom (fungal) interactions
    1. Coronado-Castellote L, Jiménez-Soriano Y. Clinical and microbiological diagnosis of oral candidiasis. J Clin Exp Dent. 2013;5(5):e279–e286.
    2. Jabra-Rizk MA, Kong EF, Tsui C, Nguyen MH, Clancy CJ, Fidel PL Jr, Noverr M. Candida albicans pathogenesis: fitting within the host-microbe damage response framework. Infect Immun. 2016;84(10):2724–2739.
    3. Li Y, Carrera C, Chen R, et al. Current and prospective therapeutic strategies: tackling Candida albicans and Streptococcus mutans cross-kingdom biofilm. Front Cell Infect Microbiol. 2023;13:1137075.
    4. Kashyap B, Kumar A, Ghosh A, et al. Candida albicans induces oral microbial dysbiosis and promotes oral diseases. Microorganisms. 2024;12(11):2138.
    Ecological patterns: necrotizing, refractory & hormonal
    1. Carrillo-de-Albornoz A, Figuero E, Herrera D, Bascones-Martínez A. Gingival changes during pregnancy: II. Influence of hormonal variations on the subgingival biofilm. J Clin Periodontol. 2010;37(3):230–240.
    2. Loesche WJ, Syed SA, Laughon BE, Stoll J. The bacteriology of acute necrotizing ulcerative gingivitis. J Periodontol. 1982;53(4):223–230.
    3. Novak MJ. Necrotizing ulcerative periodontitis. Ann Periodontol. 1999;4(1):74–78.
    4. Herrera D, Retamal-Valdes B, Alonso B, Feres M. Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo-periodontal lesions. J Clin Periodontol. 2018;45(Suppl 20):S78–S94.
    5. Slots J. Selection of antimicrobial agents in periodontal therapy. J Periodontal Res. 2002;37(5):389–398.
    6. Heller D, Silva-Boghossian CM, do Souto RM, Colombo APV. Subgingival microbial profiles of generalized aggressive and chronic periodontal diseases. Arch Oral Biol. 2012;57(7):973–982.
    Antibiotic considerations
    1. van Winkelhoff AJ, Rams TE, Slots J. Systemic antibiotic therapy in periodontics. Periodontol 2000. 1996;10:45–78.
    2. van Winkelhoff AJ, Tijhof CJ, de Graaff J. Microbiological and clinical results of metronidazole plus amoxicillin therapy in Actinobacillus actinomycetemcomitans-associated periodontitis. J Periodontol. 1992;63(1):52–57.
    3. Pavicic MJ, van Winkelhoff AJ, Douqué NH, Steures RW, de Graaff J. Microbiological and clinical effects of metronidazole and amoxicillin in Actinobacillus actinomycetemcomitans-associated periodontitis: a 2-year evaluation. J Clin Periodontol. 1994;21(2):107–112.
    4. Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Clin Periodontol. 2018;45(Suppl 20):S149–S161.
    5. Guerrero A, Griffiths GS, Nibali L, Suvan J, Moles DR, Laurell L, Tonetti MS. Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive periodontitis: a randomized placebo-controlled clinical trial. J Clin Periodontol. 2005;32(10):1096–1107.
    6. Caton JG, Armitage G, Berglundh T, et al. A new classification scheme for periodontal and peri-implant diseases and conditions — introduction and key changes from the 1999 classification. J Clin Periodontol. 2018;45(Suppl 20):S1–S8.
    7. Slots J. Low-cost periodontal therapy. Periodontol 2000. 2012;60(1):110–137.
    8. Mombelli A, Cionca N, Almaghlouth A, Décaillet F, Courvoisier DS, Giannopoulou C. Are there specific benefits of amoxicillin plus metronidazole in Aggregatibacter actinomycetemcomitans-associated periodontitis? Double-masked, randomized clinical trial of efficacy and safety. J Periodontol. 2013;84(6):715–724.
    9. Atieh MA, Shah M, Hakam A, Alghafri M, Tawse-Smith A, Alsabeeha NHM. Systemic azithromycin versus amoxicillin/metronidazole as an adjunct in the treatment of periodontitis: a systematic review and meta-analysis. Aust Dent J. 2024. doi:10.1111/adj.12991
    10. Walters J, Lai PC. Should antibiotics be prescribed to treat chronic periodontitis? Dent Clin North Am. 2015;59(4):919–933. doi:10.1016/j.cden.2015.06.011
    11. Wilson WR, Gewitz M, Lockhart PB, et al. Prevention of viridans group streptococcal infective endocarditis: a scientific statement from the American Heart Association. Circulation. 2021;143(20):e963–e978.
    12. American Dental Association. Antibiotic stewardship. ADA Oral Health Topics. Updated 2023.
    Oral-systemic associations
    1. Paul O, et al. Inflammation in periodontal disease: possible link to vascular disease. Front Physiol. 2021;11:609614.
    2. Sanz M, et al. Periodontitis and cardiovascular diseases: consensus report. J Clin Periodontol. 2020;47(3):268–288.
    3. Genco RJ, Sanz M. Clinical and public health implications of periodontal and systemic diseases. Periodontol 2000. 2020;83(1):7–13.
    4. Preshaw PM, et al. Periodontitis and diabetes: a two-way relationship. Diabetologia. 2012;55(1):21–31.
    5. Daalderop LA, et al. Periodontal disease and pregnancy outcomes: overview of systematic reviews. JDR Clin Trans Res. 2018;3(1):10–27.
    6. Dominy SS, et al. Porphyromonas gingivalis in Alzheimer’s disease brains: evidence for disease causation and treatment. Sci Adv. 2019;5(1):eaau3333.
    7. Castellarin M, et al. Fusobacterium nucleatum infection is prevalent in human colorectal carcinoma. Genome Res. 2012;22(2):299–306.
    8. Brennan CA, Garrett WS. Fusobacterium nucleatum — symbiont, opportunist and oncobacterium. Nat Rev Microbiol. 2019;17(3):156–166.
    9. Zepeda-Rivera M, et al. A distinct Fusobacterium nucleatum clade dominates the colorectal cancer niche. Nature. 2024;628:424–432.
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    OraPath by IMMYLabs · 133 Ed Noble Pkwy, Norman, OK 73072 CLIA #37D2236199 · COLA ID #32679 © 2026 OraPath by IMMYLabs, LLC. All rights reserved.

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    Every test runs in our own CLIA- and COLA-accredited lab in Norman, Oklahoma.

    Results in 2 business days from receipt

    From the moment your sample arrives, posted straight to your OraPath account.

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    Kits ship free with a prepaid return envelope included — the same for individuals and practices.

    Grounded in the literature

    Every score traces back to the published research behind it.