## 4 Discussion  
Dynamic factors of the human mouth influencing periodontal status include the influences of dietary factors, microbial activity, oral hygiene behaviors and environmental components [1; 2]. The oral mucosa serves as a critical barrier maintaining the integrity and associated barrier functions to reduce deleterious effects [1]. Components of the mucosa facilitating these functions include SA, a key molecule reported in the maintenance of oral mucosal integrity [1; 3]. In addition to its role in maintaining host physiology, oral bacteria are known to bind SA. For example, _Streptococcus gordonii_, a gram-positive bacterium that is identified as an early colonizer of oral biofilms has SA binding regions. A recent study evaluated 186 clinical strains of _S. gordonii_, collected from human subjects and reported variations in SA binding regions [6; 7]. Whereas the specific clinical outcomes of these variations remain unclear, it is possible that these variations likely contribute to the factors that influence the progression of disease. These proposals have gained recognition due to the immune disruption noted in periodontal disease due to microbial dysbiosis as an identified virulence mechanism [1; 2]. Furthermore, the sialic acid found in the glycans of the exposed epithelial surfaces of oral, gut and other mucosal barriers serves as a source of energy for microbial growth and the initial steps of microbial pathogenesis. For instance, it is estimated that more than 70 different oral organisms utilize exogenous sialic acid [7] and is known to stimulate the growth of organisms such as _Tunnerella forystthia_[8; 10]. In addition to the role of SA in host-microbial interactions, the research identifies \"siglecs\" representing sialic acid-binding immunoglobulin-type lectins expressed on the majority of white blood cells [9]. Siglecs mediate immune responses with critical roles in cell signaling with important functions in distinguishing between self and non-self which are mediated by the recognition of sialic acid-containing ligands of glycoproteins and glycolipids. Due to their expression on limited cell types, they are actively investigated for their roles in many human diseases including chronic conditions such as Alzheimer's disease, autoimmunity, neurodegeneration, etc. [3; 9; 10]. These are relevant research avenues based on recent reports exploring the potential associations between oral microbial dysbiosis and chronic diseases [1; 2; 10]. Microbial dysbiosis is a factor implicated in commonly reported oral health disease conditions such as gingivitis and periodontal disease [1; 2]. To facilitate new avenues for diagnosis and treatments, recent research directions in clinical dentistry include an emphasis on biomarkers and emerging technologies to identify the transition from health to disease [14; 16; 26; 27]. The present investigation determined salivary SA amongst subjects clinically stratified based on periodontal status. Included in this investigation was the development of a rapid chair-side visual test for patient engagement and education. This investigation enrolled adults over the age of 18 years who did not require dental or medical care and excluded those reporting systemic diseases, pregnancy and other chronic conditions. At the dental clinic, subjects underwent clinical examinations for dental plaque, gingival inflammation and bleeding utilizing established indices. Following study enrollment, subjects were provided a fluoride toothpaste and a toothbrush to standardize their oral hygiene routines. Other study standardization features included scheduling subjects for their clinical and biochemical assessments in the morning at the dental clinic. All subjects were recalled to the clinic in the morning for weekly evaluations of SA and clinical parameters to identify changes over time. Notably, in interviews subjects revealed that they had never participated in any clinical study.