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Saliva as a Diagnostic Fluid

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Dennis E. Lopatin, Ph.D. University of Michigan Overview of Lecture Applications of Sialochemistry Collection of Saliva Examples of Clinical Conditions Gingival ... – PowerPoint PPT presentation

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Title: Saliva as a Diagnostic Fluid


1
Saliva as a Diagnostic Fluid
  • Dennis E. Lopatin, Ph.D.
  • University of Michigan

2
Overview of Lecture
  • Applications of Sialochemistry
  • Collection of Saliva
  • Examples of Clinical Conditions
  • Gingival Crevicular Fluid (GCF)

3
Historical Background Diagnostic Testing
  • Rice Test (anxietydry mouthguilt)

4
Saliva as a Mirror of the Body
  • Tissue fluid levels of natural substances, as
    well as molecules introduced for therapeutic,
    dependency or recreational purposes
  • Emotional status
  • Hormonal status
  • Immunological status
  • Neurological status
  • Nutritional and metabolic influences

5
Applications of Sialochemistry
  • Diseases of the salivary glands
  • Systemic diseases where salivary glands are
    involved
  • Clinical situations in which salivary flow and
    chemistry are helpful in diagnosis or monitoring
    patient progress

6
Local Diseases
  • Obstructive- neoplastic, mucus plugs, stones
  • Inflammatory- acute viral or bacterial, chronic
    recurrent bacterial, allergic
  • Irradiation
  • Functional hyper- or hypoactivity

7
Systemic Diseases
  • Sjögrens syndrome- lymphoepithelial lesions
  • Cystic fibrosis
  • Hormonal dysfunction- diabetes, pancreatitis,
    adrenal-cortex disease, thyroid disease,
    acromegaly, menopause
  • Hypertension
  • Obesity and hyperlipidemia
  • Alcoholic cirrhosis
  • Malnutrition
  • Neurologic diseases- Parkinsons disease, Bells
    and cerebral
  • Psychogenic diseases

8
Access to Saliva from Blood
9
Clinical Situations Affecting Salivary Secretions
  • Digitalis toxicity
  • Drug monitoring
  • Environmental pollutants
  • Ovulation
  • Immunodeficiency
  • Pharmacological agents
  • Dry mouth side effects, drugs with
    parasympathetic, sympathetic and ganglionic
    blocking effects
  • Direct effects- hypersensitivity or idiosyncratic
    reaction

10
Methods of Collection of Saliva
  • Whole Saliva
  • Catheterization
  • Parotid Saliva
  • Submandibular (Submaxillary) Saliva

11
Limitations in Use of Whole Saliva
  • An admixture of parotid, submandibular and minor
    gland secretions mixed with food debris,
    bacteria, shed cells, leukocytes and other
    particulate matter.
  • Compositional studies are affected by proportions
    of secretions from different glands, as well as
    chemistry of non-salivary elements
  • In studies examining non-salivary components,
    must take care to exclude GCF, especially where
    inflammation is present.

12
Standardization of Collection
  • Resting secretions
  • need an accommodation period of at least 5
    minutes. (Influence of collection procedure as
    stimulus)
  • Stimulated saliva
  • Consistent gustatory stimulant throughout the
    study
  • Flow rate
  • Timed, focus on specific gland
  • Time of day
  • Circadian rhythm, time of collection is important

13
Salivary Studies in Cystic Fibrosis (CF)
  • CF gene cloned in 1991
  • The gene product is a cyclic AMP-regulated
    chloride ion channel named CFTR
  • Cystic Fibrosis Transmembrane Conductance
    Regulator
  • Most investigators felt that chloride and water
    secretion was the unifying key to explain the
    abnormalities and consequences of CF.
  • A disease of all exocrine glands.

14
Sialochemistry Studies of CF
  • Marked increase in calcium, proteins and
    phosphate, most evident in submandibular glands
  • Turbidity of the submandibular saliva probably
    due to precipitation of calcium-binding proteins
  • Too much overlap in calcium levels between CF and
    asthmatics to serve as screening test
  • Flow rate of saliva from labial salivary glands
    virtually absent in 90 of CF children, probably
    due to turbidity and blockage of duct

15
Diagnostic Aids in Clinical Situations
  • Digitalis toxicity (calcium and potassium)
  • Affective disorders (prostaglandin)
  • Immunodeficiency (sIgA)
  • Stomatitis in chemotherapy (albumin)
  • Cigarette usage (cotinine)
  • Gastric cancer (nitrates and nitrites)
  • Forensic medicine (blood group substance)
  • Coeliac disease (anti-IgA gliadin)
  • Liver function (caffeine clearance)

16
Malignancy
  • P53 Tumor suppressor antigen
  • inactivation in certain cancers leads to
    accumulation. Oral squamous cell carcinoma leads
    to anti-p53 antibodies in saliva
  • Salivary Defensin-1 levels elevated in oral SCC
    (made by PMNs).
  • C-erbB-2 (erb) Tumor marker associated with
    breast carcinoma.
  • CA 125 (ovarian cancer marker) associated with
    elevated salivary levels

17
Drug and Hormone Monitoring
  • Psychiatrists studying methadone advantages
    using saliva
  • humanitarian- less discomfort
  • clinical- patient acceptance of repeated testing
  • children and patients with limiting coping
    abilities
  • economic (do it yourself tests)
  • HIV therapy
  • Epilepsy

18
Drugs
19
Salivary Antibodies and Antigens
  • Advantages in large scale studies
  • Viral Screening
  • Antigen Detection
  • H. pylori (PCR of saliva)
  • Antibody Screening
  • rubella
  • hepatitis A and B
  • Shigella

20
Gingival Crevicular Fluid (GCF)
(E) Cervical enamel
(OSE) Oral sulcular epithelium
(JE) Junctional epithelium
(OE) Keratinized oral epithelium
21
Collection of GCF
  • Static fluid
  • Timed crevicular fluid flow

22
GCF Flow and Inflammation
23
GCF Flow and Probing Depth
24
GCF Flow and Menstrual Cycle
  • GCF flow highest at ovulation

25
GCF and Tetracycline Levels
Maximum GCF
Minimum GCF
Blood by finger puncture
26
Conclusions
  • Sialochemistry provides important information in
    a variety of clinical and disease states
  • Greater acceptance by patients
  • Non-invasive in most cases
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