Heikkinen AM, et al. - A sum of 252 Finnish people of age 15 to 16 years were retrospectively examined to assess the relationship of different patient-related risk indicators with developing subclinical periodontitis. They measured the following factors: periodontal indexes (bleeding on probing, visible plaque index, root calculus, and probing depth, smoking by pack-years, periodontal bacteria (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia, Prevotella nigrescens, and Treponema denticola) and the potential salivary periodontal biomarkers [active matrix metalloproteinase-8 (aMMP-8), polymorphonuclear leukocyte elastase (PMN elastase), and total protein, albumin, immunoglobulin A, immunoglobulin G, and immunoglobulin M]. They noted an association of subclinical periodontitis with elevated salivary aMMP-8. The partly calcified, dysbiotic bacterial biofilm communicating with immune defenses of the host was the main risk factor for subclinical periodontitis in adolescents. It led to gingival inflammation and further intensifying the periodontal pockets.