## 4 Discussion
A separate study suggested that high TSA could influence oxidative stress noted in inflammatory diseases including periodontitis [16]. Increased TSA levels in the saliva may play a role in the pathogenesis of periodontal disease [16,18]. However, the present study did not discriminate between gingivitis and periodontitis based on baseline values. Whereas, a variety of clinical and other variables likely impact oral SA, a likely reason includes the enrollment of less severe forms of periodontitis (mild and moderate) with a mean probing depth of 3.9 and attachment loss of 1.9 leading to statistical insignificance [20] between the evaluated subjects. The development of rapid visual chair-side tests for patient engagement is an identified goal in managing patients [1,2,28]. Notable advantages of these tests are their benefits to engage patients, enable personalization and facilitate their ability to manage their dental health. The literature recognizes previous initiatives in chair-side tests to aid patient education. A specific goal of this investigation was to develop a visual test that can be conducted with limited laboratory resources. The visual test procedures allow preparation of the filter paper disks laden with appropriate reagents at the central laboratory which can be readily transported to dental clinics under ambient conditions. No specialized equipment is needed to maintain and store these disks with the test readily performed chair-side for rapid visual results under resource-limited settings. Outcomes from this investigation outline the feasibility of utilizing this chair-side test to screen larger populations for their dental health status. A critical unmet need in the region where this investigation was conducted is the limited availability of dental health services with this requirement increasing in concern at more rural regions. It is likely features of the described test will allow for distance-based readouts using image capture and its transmittal using secure data transfer platforms facilitating longitudinal monitoring. The current results will support the design of future efforts to assess larger populations and gain insights relevant to assay design. It is estimated that these efforts will help with improving the test procedures for more sensitive and rapid assessment of collected samples. Assessment of large populations will provide insights on sialic acid status as they align with disease severity with particular reference to subjects who have marginal differences in clinical findings. Advancing research in the analysis of sialic acids and developments in chemistry will be an important factor in improving the methods presented in this effort. These advances will facilitate the selection and validation of the most appropriate and economically feasible procedures. An important focus of our future research is to study the effects of interventions on salivary sialic acid. Our interests are in assessing interventions provided to patients at the dental clinic and others that are appropriate for self-care by the subjects and available for routine use. A longer-term goal would be to utilize these results to develop appropriate testing protocols that can be used by patients to monitor their oral health status in a setting that does not require extensive laboratory resources. In addition to the above, a possible avenue for future research direction is from a recent investigation that reports sialic acid in other body fluids such as sweat. Results from that investigation examined the binding of skin bacteria to these ligands with the intent of identifying future therapeutic mechanisms to mitigate the effects of skin bacteria [34].