Current diagnostic uses of saliva

Most of the information which has been collected on salivary composition in different disease states (with the notable exception of that in digitalis intoxication) has proved of little practical diagnostic value. Diagnostic use of saliva has become more extensive in recent years, particularly in relation to estimation of systemic levels of lipid-soluble drugs and hormones. Thiocyanate levels have been used to validate self-reported frequency of tobacco-smoking, and nitrate levels have been assayed to estimate dietary nitrate intakes. The estimation of steroid hormone concentrations in saliva is now generally recognized as a means of determining systemic steroid levels which offers many advantages over estimation in serum or urine samples. Immunoassay methods now permit measurement of very small concentrations of biologically active substances in saliva.     

Variability of flow rate when collecting stimulated human parotid saliva

The aim of this study was to estimate the accuracy and reproducibility of citric‐acid‐stimulated parotid saliva sampling. In healthy volunteers a strong correlation (r² = 0.79) between flow rates from the left and right parotid gland was observed. In patients with Sjögren's syndrome this correlation (r² = 0.90) was even stronger. The intraindividual variation in healthy volunteers was 23.3 ± 5.9%. Increasing the number of collections did not reduce this variation significantly. In head and neck cancer patients, to estimate whether repeated measurements result in more reliable baseline values for use in clinical studies, repeated collections did not result in a significant reduction of intrapatient variation, similar to the results with the healthy volunteers. Thus, notwithstanding the good agreement between left and right flow rates, a high variation in parotid flow rates has to be considered when planning clinical trials evaluating the effects of treatment on salivary gland functioning.     

A modified device for collection and flow-rate measurement of submandibular-sublingual saliva

The aims of the present study were to measure stimulated submandibular-sublingual (SM-SL) salivary flow rate with a modified Block-Brottman collection device, and, further, to evaluate the reliability of measurements of stimulated SM-SL salivary flow rate by means of this modified Block-Brottman device, as compared to measurements of parotid flow rate using modified Carlson-Crittenden cups. Twenty-nine healthy female volunteers, aged 36±7 yr, were included. Saliva stimulation was achieved by application of a 3% citric acid solution to the rims of the tongue four times/min, for 3 s every 15 s. On 3 consecutive days, stimulated parotid and SM-SL salivas were collected for 2 min at 07.30, before breakfast (morning value), and at 10.00, 2 h after a standard breakfast (lunchtime values). SM-SL saliva was also collected on one occasion for 2 min ± 3. For parotid and SM-SL saliva, the mean stimulated flow rates were in the morning, 1.50±0.83 and 2.25±1.12 ml/min, and at lunchtime, 1.71±1.16 and 2.54±1.01 ml/min, respectively. For both salivas, lunchtime values were significantly higher than morning values by about 13–14%. Comparing parotid and SM-SL saliva flow rates, we found the SM-SL saliva flow rate to exceed the parotid flow rate by about 50% both in the morning and at lunchtime. Variations in flow rate were analyzed by means of ANOVA. Interindividual variance and variance between measurement days and times of day made up 88% of parotid and 83% of SM-SL total variance. By calculating the variation coefficient, we found this to be smaller for SM-SL salivary flow rate measurements as compared to parotid flow rate measurements. In conclusion, the results of the present study indicate that our method of collecting stimulated submandibular-sublingual saliva by means of a modified Block-Brottman collection device is as reliable as the method of collecting stimulated parotid saliva by means of modified Carlson-Crittenden cups, and is thus a useful method for future studies of changes in submandibular-sublingual salivary production.     

应激中述情障碍对唾液SlgA及Cor的影响

目的：探讨应激过程中述情障碍对唾液分泌型免疫球蛋白A（SIgA）及皮质醇（Cor）的影响。方法：60例高中男生为研究对象,应用多伦多述情障碍量表（TAS）评分（高分组A与低分组B）,评定其心理状况;应用放免法测定应激前后唾液SIgA和Cor浓度的变化。所得数据用t检验和单因素相关分析进行评价。结果：（1）考试前1个月和考试当天,A组学生唾液SIgA浓度均低于B组（P均〈0．05）;2组学生考试当天SIgA值和考试前1个月类似（P均〉0．05）。（2）考试前1个月和考试当天,A组学生唾液Cor浓度均显著高于B组（P均〈0．05）;2组学生考试当天Cor浓度均高于考试前1个月（其中A组P〈0．01;B组P〈0．05）;（3）2组学生应激前后SIgA、Cor变化率差异显著（其中SIgA变化率P〈0．05;Cor变化率P〈0．01）;（4）TAS总分、因子Ⅰ、因子Ⅱ与考试前1个月SIgA值、Cor变化率均显著相关（P〈0．05）;因子Ⅲ和Cor变化率呈负相关（P〈0．05）;因子Ⅳ和各测量指标无显著相关（P〉0．05）。结论：应激和应激中述情障碍均可导致唾液SIgA及唾液Cor的改变。     

唾液腺良性肿瘤患者唾液中CA125的表达及临床意义

目的:探讨唾液腺良性肿瘤患者唾液中CA125的表达及其临床意义。方法:采集30例唾液腺良性肿瘤患者和30例健康对照者的唾液,采用酶联免疫吸附分析法(ELISA)检测唾液中CA125的含量,通过统计学软件进行比较分析。结果:唾液腺良性肿瘤患者唾液中CA125的含量为506.4±75.0U/L;显著高于健康对照者唾液中CA125的含量306.0±50.1U/L(P<0.05)。结论:唾液中CA125的检测对于判断唾液腺良性肿瘤具有一定的临床应用价值。     

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涎腺疾病包括涎腺肿瘤及非肿瘤性涎腺疾病.涎腺主要依靠其分泌液--唾液发挥功能.近些年来,涎腺疾病和唾液的研究方面取得了明显的进展,本文对其中部分进展作一概述.     

Plasminogen activators and their inhibitors in human saliva and salivary gland tissue

The purpose of this study was to identify plasminogen activators (PA) and their specific inhibitors in human cell-free saliva and to investigate their expression in salivary gland tissue. Saliva samples were obtained from 34 patients visiting a neurological out-patient department. The activities of tissue and urokinase plasminogen activators (tPA and uPA, respectively), the relative inhibition of tPA, and the amounts of plasminogen activator inhibitors 1 and 2 (PAI-1 and PAI-2, respectively) in cell-free saliva were studied. The activities of tPA and uPA, and tPA inhibition, were measured using in-house microtiter plate assays, and PAI-1 and PAI-2 levels were measured using commercial enzyme-linked immunosorbent assay (ELISA) kits. Immunohistochemistry was used to evaluate the expression of PAs and PAIs in the salivary gland. Tissue plasminogen activator activity was found in most samples, with a mean activity of 0.63 IU ml(-1). uPA was observed in only a few samples. PAI-1 was not detected, but PAI-2 was present in all samples (with a mean value of 11.1 ng ml(-1)). The mean PAI-2 level in women was 12.4 and in men was 7.6 ng ml(-1). The activity of tPA and the relative inhibition of tPA seemed to be inversely associated. Tissue plasminogen activator, PAI-1, and PAI-2 were evident in salivary gland tissue, whereas the expression of uPA was low. The tPA activity in saliva suggests an active proteolysis. Plasminogen activator inhibitor 2 was found to be the main inhibitor of PAs in saliva.     

Nerve growth factor concentration in human saliva

OBJECTIVE: The aims of this study were to measure the normal concentration of nerve growth factor (NGF) in healthy human saliva and to investigate the effects of age and gender differences on saliva NGF level. MATERIALS AND METHODS: Resting whole, stimulated parotid, and stimulated submandibular/sublingual saliva were collected from 127 healthy volunteers with ages ranging from 20 to 81 years. The saliva NGF concentration was measured by enzyme immunoassay. RESULTS AND CONCLUSIONS: The mean concentrations of NGF were 901.4 +/- 75.6 pg ml(-1) in resting whole saliva, 885.9 +/- 79.9 pg ml(-1) in stimulated parotid saliva, and 1066.1 +/- 88.1 pg ml(-1) in stimulated submandibular/sublingual saliva. The stimulated submandibular saliva showed lower NGF concentrations with increasing age (rho = -0.296, P = 0.001). The NGF concentrations of resting whole saliva (P = 0.025) and stimulated parotid saliva (P = 0.005) were significantly higher in women than men. The NGF concentration of stimulated submandibular saliva was significantly higher than stimulated parotid saliva (P = 0.005) and significantly correlated with stimulated parotid saliva NGF level (rho = -0.244, P = 0.008). We found measurable concentrations of NGF in all three sources of saliva; the concentration was affected by the source for the stimulated parotid and submandibular saliva, age for stimulated submandibular saliva, and gender difference for resting whole saliva and stimulated parotid saliva.     

Clinical applications of two detection systems for HIV using saliva

The purpose of this research was to determine if the accuracy of HIV saliva and serum test results were influenced by changes in collection sites. In order to do so, serum and saliva samples were collected from 615 subjects in eight different geographic settings. The oral fluid collection/testing systems utilized were the Orapette SalivaCard HIV-1/HIV-2 antibody test (Trinity Biotech, Ireland) and the Omni-SAI/Immuno Comb II HIV 1 & 2 Saliva Test (Orgenics Ltd, Israel). For comparison, serum samples were tested by ELISA (Ortho) with reactive results confirmed via HIV-1 and HIV-2 Western blots (Biotech/Dupont, Institute Pasteur). The HIV serum and oral fluid collections were conducted in numerous test sites, which provided a great diversity in temperature, lighting and physical layout. The tests proved to be 99.8% and 100% specific, and both were 100% sensitive, regardless of the physical setting of the collections. While these systems are not currently available in the US, this study clearly demonstrates they can accurately be utilized in a variety of clinical settings, providing great promise for future applications.     

Analysis of residual saliva and minor salivary gland secretions in patients with dry mouth

The importance of oral mucosal wetness in the condition of dry mouth and the role of salivary proteins in proper oral function are acknowledged. A negative correlation between mucosal wetness and the protein concentration of residual saliva has been reported in normosalivators. Here, to examine the suggestion that a reduction in residual salivary volume leads to a concomitant elevation of its protein concentration, the amount of residual saliva and minor salivary gland secretions, and their protein concentrations, were measured in hyposalivators and normosalivator controls. A Periotron 8000 micro-moisture meter was used to measure the thickness of the mucosal film at six selected mucosal surfaces and the minor salivary gland secretion rate at two mucosal surfaces. The unstimulated whole salivary flow rate was measured by the spitting method. The total protein concentration of all salivary samples was measured by bicinchoninic acid assay. The hyposalivators had significantly lower amounts of residual saliva and minor salivary gland secretions than the normosalivators at all selected mucosal sites except the soft palate. In both groups, the site with the thinnest coat of residual saliva was the anterior hard palate and the wettest site was the anterior dorsal mucosa of the tongue. The protein concentration of residual saliva was significantly higher in hyposalivators than normosalivators. In the minor salivary gland secretions there was no significant difference in protein concentration between the normo- and hyposalivators. When the hyposalivators were divided into two subgroups according to their severity of dryness, the reduction of residual salivary volume and the elevation of protein concentration were more apparent in the group with the more severe dry mouth. Collectively, these results indicate that oral mucosal wetness is associated with the flow rate of unstimulated whole saliva. The function of the minor salivary glands was less affected and relatively well preserved in patients with dry mouth. The increased protein concentration of residual saliva in the hyposalivators appeared to be the result of decreased salivary volume.     

唾液的诊断应用研究

唾液由口腔腺体分泌产生,具有清洁和保护口腔、抗菌、消化等多种功能。随着唾液组学的发展,研究发现唾液是一个潜在的巨大生物标志物储存库。唾液采集无侵袭性、可避免病毒传播,有望成为血液的替代品。本文就关于唾液生化指标、DNA、RNA、蛋白质和微生物等生物标志物在口腔疾病、癌症、糖尿病等全身系统性疾病早期诊断中的应用,结合近期研究成果与学者观点,阐述唾液在疾病早期诊断和精准医疗中的应用前景。     

Analysis of saliva for periodontal diagnosis--a review

BACKGROUND: This review examines salivary constituents as potential diagnostic tests for periodontal disease. Saliva is a fluid that is readily available and contains locally-produced microbial and host response mediators, as well as systemic (serum) markers that may prove to be an aid in the diagnosis of periodontal disease. METHODS: A medline search was conducted and the relevant literature concerning the applications of saliva for periodontal diagnosis was reviewed. RESULTS: Based on the literature, salivary markers that have been studied as potential diagnostic tests for periodontal disease include proteins of host origin (i.e., enzymes, immunoglobulins), phenotypic markers, host cells, hormones (cortisol), bacteria and bacterial products, ions and volatile compounds. CONCLUSIONS: A number of markers show promise as sensitive measures of disease and the effectiveness of therapy. At this time, host-derived enzymes and other inflammatory mediators orginating from the gingival crevice appear to hold the greatest promise as salivary diagnostic tests for periodontal disease. Longer-term longitudinal studies, however, are required to establish the relationship between specific markers and progression of periodontal disease. Furthermore, analysis of saliva may offer a cost-effective approach to assessment of periodontal disease in large populations.     

Determination of peroxides in saliva--kinetics of peroxide release into saliva during home-bleaching with Whitestrips and Vivastyle

Aim of the study was to determine peroxides in saliva, released during bleaching procedures. Upper incisors of five subjects were bleached with Whitestrips (5% H2O2) and Vivastyle (10% carbamide peroxide, tray charged with 225mg) for 30min, each on different days. Saliva was collected before and during the whole period of bleaching at different intervals. The amount of peroxide in the salivary samples was assessed with peroxidase, phenol and 4-aminoantipyrin in a photometric assay. Additionally the amount of peroxides in the bleaching material was determined before and after the bleaching, so that the peroxide release into saliva could be balanced. The amount of peroxides released into saliva was related to the bleaching system and only partially influenced by the individual salivary flow rate. Bleaching with Vivastyle led to lower release of peroxides into saliva compared to Whitestrips (Vivastyle: 0.8+/-0.17mg; Whitestrips: 1.5+/-0.84mg). Salivary flow rate was not correlated to release of peroxides from the bleaching products. It can be concluded that the enzymatic method adopting 4-aminoantipyrin and peroxidase is valid for the determination of peroxides in saliva. Furthermore distinctly more peroxides are released into the oral cavity from Whitestrips than from trays charged with Vivastyle .     

健康人与慢性牙周炎患者唾液蛋白质量浓度及白蛋白与球蛋白比值的变化

目的 对健康人1 d内唾液总蛋白、白蛋白、球蛋白质量浓度的变化及白蛋白与球蛋白比值（A/G）进行检测、分析,确定唾液蛋白成分较稳定的时间段,并比较此时间段健康人与慢性牙周炎患者非刺激性全唾液中的蛋白质量浓度及A/G的变化,为以唾液为基础的疾病诊断学方法建立和临床应用提供参照。方法 分别采集37名健康受试者（健康组）8:00、9:30、11:30、13:00、16:30、21:00的全唾液,并取24名慢性牙周炎患者（牙周炎组）早晨的全唾液。使用BCA法在酶标仪上检测总蛋白质量浓度,用GF-D800型半自动生化分析仪检测唾液白蛋白的质量浓度,然后计算球蛋白质量浓度及A/G。使用SPSS 19.0统计软件对所得数据进行统计学分析。结果 唾液蛋白成分在早晨（8:00）空腹时较为稳定。在这段时间,健康组总蛋白（1 354.35±389.52）μg•mL-1、白蛋白（139.55±27.19）μg•mL-1、球蛋白（1 211.80±360.73）μg•mL-1、A/G 0.126 3±0.041 7;牙周炎组总蛋白（2 611.56±231.62）μg•mL-1、白蛋白（296.27±17.34）μg•mL-1、球蛋白（2 315.69±221.67）μg•mL-1、A/G 0.156 2±0.017 3。健康组总蛋白、白蛋白、球蛋白的质量浓度在1 d内不同时间存在明显差异（P<0.05）,主要体现在饭前与饭后的差异,但A/G在1 d内基本稳定。对健康组与牙周炎组的唾液蛋白及A/G进行比较,牙周炎组的唾液总蛋白、白蛋白、球蛋白质量浓度较健康组明显升高,但A/G无明显差异。结论 唾液蛋白成分在早晨空腹时较其他时段稳定,可为样本采集时间提供参考。慢性牙周炎患者的唾液总蛋白、白蛋白、球蛋白质量浓度较健康人明显升高。     

Film-forming properties and viscosities of saliva substitutes and human whole saliva

Hypo-salivation, related to medical remedies, is an increasing clinical problem. Studies report a weak correlation between subjective mouth dryness and objective sialometry. This indicates that both quantity and quality of saliva are important for the surface-associated functions of saliva, such as lubrication and hydration, to be expressed. Film-forming properties and viscosities of three saliva substitutes were compared to human saliva. Adsorption to surfaces was measured by ellipsometry, infrared spectroscopy and drop-volume technique. Viscosity measurements were carried out using an oscillating rheometer. Saliva, with the lowest viscosity value and the highest protein content, presented superior film retention on both hydrophilic and hydrophobic surfaces. The carboxymethylcellulose-based MAS 84 showed intermediate values of viscosity, poorest ability to reduce surface tension, and negligible film-forming capacity. The porcine mucin-based Saliva Orthana showed about twice the viscosity of saliva and film-forming capability on preferably hydrophobic substrates. Salinum, a linseed extract, possessed the highest viscosity value and an initial surface tension close to that of saliva. The film retention on hydrophilic surfaces was not as effective as for saliva. The results indicate that the film-forming capacity of saliva substitutes is a property also to be considered in the exploration of clinically effective artificial salivas.     

The effect of artificial saliva on the rheological properties of tooth whitening systems

This work was undertaken to explore the effect of saliva addition on the rheological properties of two contrasting tooth bleaching systems, one of which was a paste (Colgate Platinum) and the other a gel (Zaris, 3M ESPE). Using a dynamic stress rheometer with cone and plate geometry, it was shown that addition of artificial saliva reduced the apparent viscosity of each material. However, in some cases this was accompanied by an increase in elasticity. It is suggested that saliva may not have a deleterious effect on the ability of the materials to remain in the bleaching tray.     

Effect of sorbitol- and xylitol-containing chewing gum on salivary microflora, saliva, and oral sugar clearance

Abstract – The effect of frequent use of a sorbitol-containing nicotine chewing gum on saliva secretion rate and buffer capacity and some oral bacteria was studied in 27 patients at a smoking cessation clinic. The effect was compared with that obtained after frequent use of a chewing gum containing xylitol in a second study in 14 subjects. The results showed that sorbitol-containing nicotine chewing gum had no significant effect on salivary numbers of oral streptococci and lactobacilli during a 3-month period of active chewing five times a day. Chewing on xylitol-containing gum caused a significant decrease in salivary S. mutans after 2 months but not after 3 months. No change in secretion rate or buffer capacity was observed in the two studies. Oral sugar clearance time was reduced after 3 months with a statistically significant difference to baseline values in subjects consuming the sorbitol-containing nicotine chewing gum.     

Levels of aspartate aminotransferase (AST) in saliva of patients with different periodontal conditions

OBJECTIVES: The purpose of this study was to evaluate the relationship between aspartate aminotransferase (AST) levels in saliva measured by Reflotron trade mark System of Diagnosis and periodontal condition indicated by Community Periodontal Index of Treatment Needs (CPITN). MATERIAL AND METHODS: Fifteen patients were assigned to one of four groups C0, C1, C3 and C4, based on their largest CPITN code among the examined sites, totaling 60 participants. About 1.0 ml of non-stimulated saliva was collected from the individuals after a mouth rinse with water. Biochemical analyses of saliva samples were carried out using the proposed system in order to quantify their AST concentration. RESULTS: There were no significant differences between levels (U/ml) of AST (median; interquartile range) from groups C0 (30.9; 14.7-41.7), C1 (30.3; 19.5-39.4) and C3 (35.1; 27.0-63.5). However, group C4 (106.2; 84.4-129.7) differed statistically from the others (p<0.001) and presented AST levels as high as 284.2 U/ml. Gingival bleeding and suppuration were observed in three individuals with concentrations higher than 125.0 U/ml. CONCLUSION: Levels of AST in saliva from patients presenting CPITN code 4 were higher than from patients coded lower and could be detected by the evaluated diagnostic system. Periodontal destruction such as periodontal pockets, gingival bleeding and suppuration seems to be related to higher AST levels in saliva.