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