Sensitive, Low-Cost, Early Detection of Periodontal Disease Using Surface-Enhanced Raman Spectroscopy with Easy-to-Use Silver Nanomesh-Coated Periopaper

Periodontal disease is a widespread inflammatory condition, with growing recognition as a contributor to systemic diseases, including cardiovascular, metabolic, and neurodegenerative disorders. Early diagnosis is critical for effective intervention, yet current methods, such as periodontal probing, X-ray imaging, PCR testing, and salivary biomarker testing, are limited by invasiveness, operator dependence, cost, or low sensitivity. Here, we present a sensitive, low-cost, and user-friendly method for early periodontal disease detection using surface-enhanced Raman spectroscopy with a silver-nanomesh-coated periopaper strip. This flexible substrate enables the in situ analysis of gingival crevicular fluid biomarkers without the need for sample preparation. The platform addresses key limitations of existing methods by providing high sensitivity for early-stage detection, a broad biochemical profile, repeatable measurements for longitudinal monitoring, and greater environmental stability than saliva-based assays. In a clinical study involving 43 teeth from 34 participants, our system reliably detected disease severity, including cases with probing pocket depths of up to 10 mm. Given its simplicity, affordability, and robustness, this approach is well-suited for use in primary care or resource-limited settings. Moreover, its extensibility to other biomarker targets highlights its potential for broader application in the diagnosis of both oral and systemic diseases.