Pemeriksaan Saliva

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Pemeriksaan Saliva


  • Saliva

    cairan ekstraseluler yang diproduksi kelenjar saliva dalam mulut

    • saliva and other oral fluids (e.g. oral mucosal cellular secretions, gingival crevicular fluid) support the health of soft and ahrd tissues in the oral cavity
  • Kelenjar saliva

    • Major salivary gland

      • parotid gland
      • submandibular gland
      • sublingual gland
    • Minor salivary glands

      hundreds through out mout


  • Produksi saliva

    • Produksi saliva normal pada orang dewasa: 500-1500 ml per hari, at a rate of approximately 0,5 mL/min
    • dipengaruhi stimulus: mengunyah, psikologis, hormonal, obat, usia, exercise, OH
    • Several physiological and pathological conditions can modify saliva produkction quantitatively and qualitatively
    • smell and taste stimulate saliva produkction and secretion, as do chewing, psychological and hormonal status, drugs, age, hereditary influences, oral hygiene, and physical exercise
  • Kandungan saliva

    • air 99,5%
    • organic compound- mucin, amylase, lysozym
    • anorganic compounds-HCO3, K, Cl, Na, Ca, Phosphate dll
  • Fungsi Saliva

    • control oral pH
    • assist with food intake
      • lubricates food bolus
      • cotain amylase for carbohydrate digestion
    • Mouth cleansing and oral hygiene
      • saliva limits oral pathogen growth
      • reduces oral odor (halitosis)
    • re-mineralizes enamel
    • buffers cariogenic
    • removes food residue
    • inhibits bacterial growth
  • Diagnostic Potensi

    • Perbandingan saliva dan serum sampling (darah)

      • saliva offers increased flexibility, cost effectiveness, convenience, and is less invasive compared with serum sampling
      • The collection of saliva
        • noninvansive and negates the need for trained medical staff
        • a stress-free, painless, and economically viable manner
      • saliva is being chosen as the biological medium of choice in studies involving children
      • Saliva also presents less risk of infection to the technical staff involved in the processing and assaying of biological samples compared with blood

      Saliva: tidak invasif, tidak menimbulkan nyeri

  • Whole saliva

    • sekresi kelenjar saliva mayor dan minor
    • transudasi mukosa
    • cairan gingival crevicular
    • serum and blood derivatives from oral wounds, desquamated epithelial cells, expectorated bronchial and nasal secretions, bacteria and bacterial products, viruses and fungi, other cellular components, and food debris
    • hormones, proteins, enzymes, antibodies, antimicrobial constituents, and cytokines
    • serum dan darah, deskuamasi sel epitel, produksi bakteri/ bakteri, hormon, protein, enzim, antibodi (igA)
  • Mekanisme keluarnya zat darah pada saliva

    • transeluler
    • difusi intraseluler pasif
    • active transport
    • paraseluler (antar sel) by extracelullar ultrafiltration within the salivary glands
    • gingical crevicular


  • Metode Pemeriksaan Saliva

    • unstimulated

      15 menit tanpa stimulasi (2x15)

    • stimulated

      15 menit mengunyah paraffin gum (2x15)

    • Normal

      greater than 8-10 mL

    • Pathological

      < 8ml/ day (Xerostomia)

      1-2L /day (Ptyalism)

  • Saliva as a biomarker of oral disease


  • Salivary analysis

    Saliva can be done for the diagnosis of the following conditions:

    • hereditary disease (genetic disorders)
    • autoimmune disease
    • malignancy
    • infection
    • monitoring of levels of hormones
    • monitoring of levels of drugs
    • bone turnover marker in saliva
    • forensic evidence
    • oral diseases (dental caries, periodontal disease)
    • diagnosis of oral disease with relevance for systemic diseases
      • DM
      • CVD
      • Renal disease
  • Ptyalism

    • causes of salivary overproduction
      • pregnancy (ptyaslism gravidarum)
      • excessive starch intake
      • gastrointestinal causes
        • acute gastritis or gastric ulcer
        • pancreatitis
        • liver disease
      • stomatitis and localized oral lesions
      • oral infectious lesions
    • Ptyalism
      • ptyalism may result in 1-2L/day of saliva secretion
      • Mechanism of excessive saliva
        • decreased saliva swallowing and clearance
        • excessive saliva production
        • neuromuscular disease
        • anatomic abnormalities
  • Sialadenitis

    • Acute

      viral and bacterial infection

    • Chronic

      bacterial, fibroproductive, spesific (actinomycosis, syfilis, TBC), immunosialadenitis

    • Acute viral sialadenitis

      • parotitis acuta
      • paramyxovirus
      • neurothropic effect-n.VIII
      • affection of gonadal tissues, pancreas, central nervous system
      • incubation: 18 days
      • whole life immunity
    • Acute bacterial

      • ascendent ductal infection
      • dehydration, diabetes, renal disease, wrong dental hygiene, inflammation in mouth and pharynx
    • Chronic bacterial parotitis

      • predisposition- ectasy of salivary ducts- congenital, postinfectious, obstructive, immunopatological
  • Sialolithiasis

    • stones composed of Ca salts often obstruct salivary glands, causing pain, swelling, and sometimes infection
    • diagnosis is made clinically or with CT, ultrasound, or sialogram
    • treatment involves stone expression with saliva stimulants, manual manipulation, a probe, or surgery
    • Dental caries and periodontal disease
      • Saliva its use in monitoring the level of oral bacteria
      • The increased number of Streptococcus mutans and lactobacilli in saliva have been associated with increased caries prevalence and root caries
      • Periodontal disease have been associated with increased levels of AST and ALP
      • Lower levels of uric acid and albumin in the saliva were associated with periodontitis and diabetes
  • Autoimun

    • Sjogren's syndrome
      • characterized by keratoconjuctivitis sicca and xerostomia
      • reduced secretion of the salivary glands and lacrimal glands and associated endocrine disturbance
      • Salivary protein analysis
        • increased level of lactoferrin, beta 2 microglobulin, lysozyme C, and cystatin C
        • decreased of salivary amylase and carbonic anhydrase
  • multiple sclerosis

    • multiple sclerosis (MS) is an inflammatory disease characterized by loss of myelin and scarring
    • caused due to destruction/ failure of myelin producing cells by the immune system
    • salivary diagnostic is a reduction in IgA production
  • Cardiovascular diseases (Acute coronary syndromes)

    • It is characterized by atherosclerotic plaques which rupture and cause clinical symptoms ranging from chest pain to acute myocardial infarction (AMI)
    • Salivary markers
      • C-reactive protein (CRP)
      • myoglobin (MYO), creatinine kinase myocardial band (CKMB), cardiac troponin (cTn)
      • the salivary MYO elvels are significantly higher within 48h of onset of chest pain in AMI paients
  • Diabetes Mellitus

    • Disabetes is a metabolic disease caused by insufficient insulin secretion, or insulin resistance, which leads to a glucose metbaolism disorder
    • alfa-2-macroglobulin in the saliva could reflect the glycaemic control in patients with type 2 diabetes mellitus
  • malignancy

    early detection is the key to good prognosis in almost all types of cancer

    Saliva has been used as diagnostic:

    • proteins, mRNA, and DNA of cancer cell
    • p53 antibody in oral squamous cell carcinoma (OSCC)
    • CA15-3, c-erb-2: breast cancer
    • CA 125: oral, breast, and ovarial tumour
    • PSA: prostat ca
  • advantages of saliva hormone testing

    • stress-free
    • noninvansive (no needles)
    • less expensive/more convenient for health care provider and patient
    • optimized for collection any time of day/month, any place
    • no special proessing (eg, centrifugation, ice-packs) prior to shipment
    • hormones stable in saliva for prolonged period of time
    • convenient shipment
    • more representative than serum of total bioavailable steroid hormone levels
  • disadvantage of saliva hormone testing

    • interfering substances-food, beverage
    • saliva easily contaminated with topical hormone on lips or hands
    • spurior results with periodontal disease
    • lack of familiarity (serum is gold standard)
    • sublingual use of hormones often leads to innacurate (high) results
    • topical application of hormones result in saliva levels higher

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