Related Experiment Video
Updated: Aug 12, 2026
Developing a Salivary Antibody Multiplex Immunoassay to Measure Human Exposure to Environmental Pathogens
Published on: September 12, 2016
Evaluating Oral Fluid as a Screening Tool for Lead Poisoning
Sher Lynn Gardner1, Robert J Geller2,3, Robyn Hannigan4
1Emory University School of Medicine, Pediatrics, Atlanta, GA, USA.
Insights
Screening young children for lead poisoning using oral fluid is feasible and effective. This method has a 100% negative predictive value, reducing the need for blood samples in over half of cases.
Area of Science:
- Pediatric Health
- Toxicology
- Clinical Diagnostics
Background:
- Lead poisoning screening is crucial for young children.
- Current blood lead testing methods can be difficult and unpleasant for children.
- Alternative, less invasive screening methods are needed to improve screening rates.
Purpose of the Study:
- To assess the correlation between oral fluid and blood lead levels in a clinical setting.
- To determine the acceptability and feasibility of collecting oral fluid samples from young children.
- To evaluate oral fluid as a viable alternative for lead screening.
Main Methods:
- Oral fluid samples were collected from 431 children (6 months to 5 years) undergoing blood lead testing.
- Blood lead levels were measured concurrently for comparison.
- Statistical analyses included Pearson correlations, linear regression, ANOVA, and Bland-Altman analysis.
Main Results:
- A 100% negative predictive value was observed for oral fluid lead screening.
- Oral fluid screening eliminated the need for blood samples in over 50% of children.
- No cases of elevated blood lead were missed by the oral fluid screening method.
Conclusions:
- Oral fluid screening for lead poisoning is a feasible and accurate alternative to blood testing.
- This method significantly improves patient comfort and potentially increases screening participation.
- Oral fluid testing offers a highly reliable way to rule out elevated lead levels.
Context:
Screening for lead poisoning is necessary in young children, but obtaining the needed blood sample is unpleasant and sometimes very difficult. Use of an alternative screening method that is less unpleasant and less difficult would likely help to increase the percent of children receiving screening.
Objectives:
To evaluate the correlation of oral fluid and blood lead in a clinical setting, and to ascertain the acceptability and feasibility of obtaining oral fluid from a young child in the clinical setting.
Methods:
Oral fluid samples were collected from a convenience sample of 431 children aged 6 months to 5 years already due to receive a blood lead test in a primary care clinic. Blood lead results obtained at the same time were available for 407 children. The results of the two tests were compared with the blood lead test considered to be the "gold standard". Data analysis used Pearson correlations, scatter plots, linear regression, ANOVA and Bland-Altman analysis.
Results:
431 patients had oral fluid samples available for analysis, and 407 patients had blood samples available. Patients who had both blood concentrations <5 µg/dL and oral fluid values below the screening cutoff value were 223, while eight had both blood concentrations ≥ 5 µg/dL and oral fluid values above the screening threshold. Elevated oral fluid but blood lead values less than the value recommended for further intervention occurred in 176; no patients had elevated blood lead values with below-intervention oral fluid values. The negative predictive value of an oral fluid lead below the screening cutoff value was 100%.
Conclusions:
The use of oral fluid to screen for elevated body burdens of lead instead of the usual blood lead sample is feasible with a negative predictive value of 100%, while eliminating the need for blood for lead screening in more than half of these children.
