Non-Cochrane · aetiology · PM42829381
Association between salivary alkaline phosphatase levels and periodontal disease: a systematic review and meta-analysis.
Alarcón-Sánchez Mario Alberto, Lomelí-Martínez Sarah Monserrat, Ortuño-Sahagún Daniel, et al. · BDJ open · 2026 · PubMed · doi:10.1038/s41405-026-00488-z
Findings
Population Adults with periodontal disease or healthy periodontium
22 findings
| Gingivitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline | MD 16.05 [-10.14, 42.25] Very low Downgraded: risk of bias, imprecision, inconsistency 4 studies · 238 participants |
| Periodontitis | Gingivitis | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline | MD 38.94 [-32.36, 110.25] Very low Downgraded: risk of bias, imprecision, inconsistency 4 studies · 220 participants |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline · Leave-one-out: Totan 2006 excluded | MD 46.31 [22.03, 70.58] GRADE not reported 11 studies |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline · Leave-one-out: Kido 2026 excluded | MD 47.75 [24.45, 71.06] GRADE not reported 11 studies |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline · Leave-one-out: Todorovic 2005 excluded | MD 46.01 [21.62, 70.4] GRADE not reported 11 studies |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline · Leave-one-out: Rasaei 2022 excluded | MD 43.76 [19.31, 68.21] GRADE not reported 11 studies |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline · Leave-one-out: Agnihotram 2010 excluded | MD 44.44 [19.86, 69.01] GRADE not reported 11 studies |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline · Unstimulated saliva | MD 49.94 [24.44, 75.45] GRADE not reported 10 studies · 683 participants |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline · Published before 2015 | MD 27.39 [13.21, 41.58] GRADE not reported 6 studies · 444 participants |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline · Prospective longitudinal studies | MD 52.55 [0.82, 104.28] GRADE not reported 4 studies · 259 participants |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline · Leave-one-out: Parihar 2024 excluded | MD 41 [18.07, 63.92] GRADE not reported 11 studies |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline · Leave-one-out: Luke 2015 excluded | MD 37.67 [20.93, 54.41] GRADE not reported 11 studies |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline · Stimulated saliva | MD 19.43 [-139.17, 178.03] GRADE not reported 2 studies · 144 participants |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline · Leave-one-out: Koppolu 2021 excluded | MD 41.7 [18.5, 64.9] GRADE not reported 11 studies |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline · Published 2015 onwards | MD 63.65 [19.74, 107.57] GRADE not reported 6 studies · 383 participants |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline · Leave-one-out: Dabra 2012 excluded | MD 46.98 [23.09, 70.86] GRADE not reported 11 studies |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline · Leave-one-out: Nomura 2006 excluded | MD 48.07 [25.14, 71] GRADE not reported 11 studies |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline · Leave-one-out: Al-Maliki 2024 excluded | MD 45.98 [21.58, 70.39] GRADE not reported 11 studies |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline · Leave-one-out: Ikekpeazu 2011 excluded | MD 46.22 [21.89, 70.54] GRADE not reported 11 studies |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline · Cross-sectional studies | MD 40.88 [9.53, 72.22] GRADE not reported 8 studies · 568 participants |
| Periodontitis | Periodontally healthy | Salivary alkaline phosphatase activity (U/L or IU/L) Baseline | MD 44.62 [22.54, 66.69] Very low Downgraded: risk of bias, imprecision, inconsistency 12 studies · 817 participants |
| Salivary alkaline phosphatase levels | Not specified | Correlation with clinical periodontal parameters Baseline | no estimate extracted GRADE not reported 3 studies |
Included primary studies 20
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Ramenzoni 2021 Oral Diagnostic Methods for the Detection of Periodontal Disease. PMID:33810094 | 2021 | 1 other review | not stated | not extracted yet |
| Agnihotram 2010 matched by author and year (probable) | NR | this review only | Salivary alkaline phosphatase activity (U/L or IU/L) | not extracted yet |
| Al-Maliki 2024 DOI:10.48309/jmpcr.2024.448523.1144 | NR | this review only | Salivary alkaline phosphatase activity (U/L or IU/L) | not extracted yet |
| Dabra 2012 Salivary enzymes as diagnostic markers for detection of gingival/periodontal disease and their correlation with the severity of the disease. PMID:23162329 | 2012 | this review only | Salivary alkaline phosphatase activity (U/L or IU/L) | not extracted yet |
| Deepika 2015 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Ikekpeazu 2011 Periodontal disease and type 2 diabetes: effects on salivary enzyme activities DOI:10.1007/s13410-010-0005-z | 2011 | this review only | Salivary alkaline phosphatase activity (U/L or IU/L) | not extracted yet |
| Jeyasree 2018 Evaluation of serum and salivary alkaline phosphatase levels in chronic periodontitis patients before and after nonsurgical periodontal… PMID:30631226 | 2018 | this review only | not stated | not extracted yet |
| Kido 2026 Evaluation of salivary calprotectin as a marker for screening periodontitis using a latex agglutination turbidimetric immunoassay system:… PMID:41501804 | 2026 | this review only | Salivary alkaline phosphatase activity (U/L or IU/L) | not extracted yet |
| Koppolu 2021 Alkaline phosphatase and acid phosphatase levels in saliva and serum of patients with healthy periodontium, gingivitis, and periodontitis… PMID:33424320 | 2021 | this review only | Salivary alkaline phosphatase activity (U/L or IU/L) | not extracted yet |
| Luke 2015 Estimation of Specific Salivary Enzymatic Biomarkers in Individuals with Gingivitis and Chronic Periodontitis: A Clinical and Biochemical… PMID:26435618 | 2015 | this review only | Salivary alkaline phosphatase activity (U/L or IU/L) | not extracted yet |
| Nakamura 1983 Salivary enzymes. Origin and relationship to periodontal disease. PMID:6230429 | 1983 | this review only | not stated | not extracted yet |
| Nomura 2006 Screening of periodontitis with salivary enzyme tests. PMID:17220614 | 2006 | this review only | Salivary alkaline phosphatase activity (U/L or IU/L) | not extracted yet |
| Nomura 2012 Salivary biomarkers for predicting the progression of chronic periodontitis. PMID:22030151 | 2012 | this review only | not stated | not extracted yet |
| Parihar 2024 Comparative evaluation of salivary, serum, and GCF alkaline phosphatase levels in chronic periodontitis patients before and after… PMID:39234139 | 2024 | this review only | Salivary alkaline phosphatase activity (U/L or IU/L) | not extracted yet |
| Patel 2016 Estimation and Comparison of Salivary Calcium, Phosphorous, Alkaline Phosphatase and pH Levels in Periodontal Health and Disease: A… PMID:27630955 | 2016 | this review only | not stated | not extracted yet |
| Rasaei 2022 Evaluation of alkaline phosphatase in gingival crevicular fluid and saliva of patients with periodontitis and healthy individuals. PMID:36992995 | 2022 | this review only | Salivary alkaline phosphatase activity (U/L or IU/L) | not extracted yet |
| Risteska 2021 Diagnostic and Prognostic Markers of Periodontal Disease. PMID:35032371 | 2021 | this review only | not stated | not extracted yet |
| Todorovic 2005 Salivary enzymes and periodontal disease. PMID:16505786 | 2006 | this review only | Salivary alkaline phosphatase activity (U/L or IU/L) | not extracted yet |
| Totan 2006 Salivary aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase: possible markers in periodontal diseases? PMID:16681433 | 2006 | this review only | Salivary alkaline phosphatase activity (U/L or IU/L) | not extracted yet |
| Yaghini 2020 Evaluation of salivary calcium, phosphorus and alkaline phosphatase concentrations before and after the first phase of periodontal… PMID:35919747 | 2020 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| The role of salivary lactoferrin as a potential biomarker for periodontal disease: a systematic review and meta-analysis. (2026) | 1 | 0.02 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (>18 years, both sexes) with gingivitis or periodontitis diagnosed by clinical criteria (PD, CAL and/or radiographic bone loss) and periodontally healthy controls; excluded systemic disease only, anti-inflammatory/antibiotic/corticosteroid use, prior periodontal treatment, pregnancy/breastfeeding, smoker- or alcohol-only populations | 1459 participants aged 18-81 years (171 gingivitis, 775 periodontitis, 513 periodontally healthy) in 20 studies from 11 countries |
| Intervention | Gingivitis; periodontitis (exposure: periodontal disease status) | Periodontitis (n=20 studies; 12 in meta-analysis); gingivitis (n=6 studies; 4 in meta-analysis) |
| Comparison | Periodontally healthy individuals | Periodontally healthy controls (n=12 meta-analyzed for periodontitis, 4 for gingivitis); gingivitis as comparator for periodontitis (n=4) |
| Outcomes | Primary: salivary ALP levels measured by spectrophotometric, colorimetric or enzymatic methods; secondary: correlation of salivary ALP with clinical periodontal parameters | Salivary ALP (U/L or IU/L) pooled for gingivitis vs healthy (n=4), periodontitis vs gingivitis (n=4), periodontitis vs healthy (n=12); correlation with PD, CAL, BOP, PI, GI, RBL reported narratively (n=3) |
| Study designs | Prospective cross-sectional and longitudinal clinical studies; excluded case reports/series, RCTs, in vitro/animal studies, brief communications, conference abstracts, bibliometric studies, reviews | Cross-sectional (n=13); prospective longitudinal (n=7) |
| Timing | Not specified | Studies published 1983-2026; baseline comparisons used |